Evaluation of Computer-generated Reminders to Improve CD4 Laboratory Monitoring in Sub-Saharan Africa: a Prospective Comparative Study

Overview

Journal J Am Med Inform Assoc

Publisher Oxford University Press

Specialty Medical Informatics

Date 2011 Jan 22

PMID 21252053

Citations 19

Authors

Martin C Were

Changyu Shen

William M Tierney

Joseph J Mamlin

Paul G Biondich

Xiaochun Li

Sylvester Kimaiyo

Burke W Mamlin

Affiliations

Soon will be listed here.

Abstract

Objective: Little evidence exists on effective interventions to integrate HIV-care guidelines into practices within developing countries. This study tested the hypothesis that clinical summaries with computer-generated reminders could improve clinicians' compliance with CD4 testing guidelines in the resource-limited setting of sub-Saharan Africa.

Design: A prospective comparative study of two randomly selected outpatient adult HIV clinics in western Kenya. Printed summaries with reminders for overdue CD4 tests were made available to clinicians in the intervention clinic but not in the control clinic.

Measurements: Changes in order rates for overdue CD4 tests were compared between and within the two clinics.

Results: The computerized reminder system identified 717 encounters (21%) with overdue CD4 tests. Analysis by study assignment (regardless of summaries being printed or not) revealed that with computer-generated reminders, CD4 order rates were significantly higher in the intervention clinic compared to the control clinic (53% vs 38%, OR = 1.80, CI 1.34 to 2.42, p < 0.0001). When comparison was restricted to encounters where summaries with reminders were printed, order rates in intervention clinic were even higher (63%). The intervention clinic increased CD4 ordering from 42% before reminders to 63% with reminders (50% increase, OR = 2.32, CI 1.67 to 3.22, p < 0.0001), compared to control clinic with only 8% increase from prestudy baseline (CI 0.83 to 1.46, p = 0.51). Limitations Evaluation was conducted at two clinics in a single institution.

Conclusions: Clinical summaries with computer-generated reminders significantly improved clinician compliance with CD4 testing guidelines in the resource-limited setting of sub-Saharan Africa. This technology can have broad applicability to improve quality of HIV care in these settings.

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References

Bryan C, Boren S . The use and effectiveness of electronic clinical decision support tools in the ambulatory/primary care setting: a systematic review of the literature. Inform Prim Care. 2008; 16(2):79-91. DOI: 10.14236/jhi.v16i2.679. View

Narasimhan V, Brown H, Pablos-Mendez A, Adams O, Dussault G, Elzinga G . Responding to the global human resources crisis. Lancet. 2004; 363(9419):1469-72. DOI: 10.1016/S0140-6736(04)16108-4. View

McDonald C . Protocol-based computer reminders, the quality of care and the non-perfectability of man. N Engl J Med. 1976; 295(24):1351-5. DOI: 10.1056/NEJM197612092952405. View

Samb B, Celletti F, Holloway J, Van Damme W, De Cock K, Dybul M . Rapid expansion of the health workforce in response to the HIV epidemic. N Engl J Med. 2007; 357(24):2510-4. DOI: 10.1056/NEJMsb071889. View

Chen L, Evans T, Anand S, Boufford J, Brown H, Chowdhury M . Human resources for health: overcoming the crisis. Lancet. 2004; 364(9449):1984-90. DOI: 10.1016/S0140-6736(04)17482-5. View

Shea S, DuMouchel W, BAHAMONDE L . A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. J Am Med Inform Assoc. 1996; 3(6):399-409. PMC: 116324. DOI: 10.1136/jamia.1996.97084513. View

Dexter P, Perkins S, Overhage J, Maharry K, Kohler R, McDonald C . A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med. 2001; 345(13):965-70. DOI: 10.1056/NEJMsa010181. View

Nicholas D, Heiby J, Hatzell T . The Quality Assurance Project: introducing quality improvement to primary health care in less developed countries. Qual Assur Health Care. 1991; 3(3):147-65. DOI: 10.1093/intqhc/3.3.147. View

Overhage J, Tierney W, Zhou X, McDonald C . A randomized trial of "corollary orders" to prevent errors of omission. J Am Med Inform Assoc. 1997; 4(5):364-75. PMC: 61254. DOI: 10.1136/jamia.1997.0040364. View

10.

Cresswell K, Sheikh A . Information technology-based approaches to reducing repeat drug exposure in patients with known drug allergies. J Allergy Clin Immunol. 2008; 121(5):1112-1117.e7. DOI: 10.1016/j.jaci.2007.12.1180. View

11.

McDonald C, Hui S, Smith D, Tierney W, Cohen S, Weinberger M . Reminders to physicians from an introspective computer medical record. A two-year randomized trial. Ann Intern Med. 1984; 100(1):130-8. DOI: 10.7326/0003-4819-100-1-130. View

12.

Mamlin B, Biondich P, Wolfe B, Fraser H, Jazayeri D, Allen C . Cooking up an open source EMR for developing countries: OpenMRS - a recipe for successful collaboration. AMIA Annu Symp Proc. 2007; :529-33. PMC: 1839638. View

13.

Seebregts C, Mamlin B, Biondich P, Fraser H, Wolfe B, Jazayeri D . The OpenMRS Implementers Network. Int J Med Inform. 2009; 78(11):711-20. DOI: 10.1016/j.ijmedinf.2008.09.005. View

14.

Were M, Mamlin B, Tierney W, Wolfe B, Biondich P . Concept dictionary creation and maintenance under resource constraints: lessons from the AMPATH Medical Record System. AMIA Annu Symp Proc. 2008; :791-5. PMC: 2655913. View

15.

Dovlo D . Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review. Hum Resour Health. 2004; 2(1):7. PMC: 455693. DOI: 10.1186/1478-4491-2-7. View

16.

Kumar P . Providing the providers - remedying Africa's shortage of health care workers. N Engl J Med. 2007; 356(25):2564-7. DOI: 10.1056/NEJMp078091. View

17.

Davis D, OBrien M, Freemantle N, Wolf F, Mazmanian P, Taylor-Vaisey A . Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes?. JAMA. 1999; 282(9):867-74. DOI: 10.1001/jama.282.9.867. View

18.

Safran C, Rind D, Davis R, Ives D, Sands D, Currier J . Guidelines for management of HIV infection with computer-based patient's record. Lancet. 1995; 346(8971):341-6. DOI: 10.1016/s0140-6736(95)92226-1. View

19.

Morrow R, Gooding A, Clark C . Improving physicians' preventive health care behavior through peer review and financial incentives. Arch Fam Med. 1995; 4(2):165-9. DOI: 10.1001/archfami.4.2.165. View

20.

Kober K, Van Damme W . Scaling up access to antiretroviral treatment in southern Africa: who will do the job?. Lancet. 2004; 364(9428):103-7. DOI: 10.1016/S0140-6736(04)16597-5. View