Assessment and improvement of HIV screening rates in a Midwest primary care practice using an electronic clinical decision support system: a quality improvement study

Marcelin, Jasmine R.; Tan, Eugene M.; Marcelin, Alberto; Scheitel, Marianne R.; Ramu, P; Hankey, Ronald A.; Keniya, Pritesh; Wingo, Majken T.; Rizza, Stacey A.; North, Frederick; Chaudhry, Rajeev

doi:10.1186/s12911-016-0320-5

Cited by 26 publications

(33 citation statements)

References 41 publications

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“…Clinicians and allied health professionals may be key influencers of how youth adopt the use of patient portals for STI test disclosures as new health behaviors. The PHR impact latent construct may be collected (i.e., using an electronic health record (EHR) e-form) in clinical settings to prioritize the delivery interventions empowering STI test disclosure [ 45 , 46 ]. Sex partners and family may additionally be effective interpersonal communication channels to support the adoption of sharing STI PHRs.…”

Section: Resultsmentioning

confidence: 99%

Digital technology to address HIV and other sexually transmitted infection disparities: Intentions to disclose online personal health records to sex partners among students at a historically Black college

et al. 2020

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Patient portals are creating new opportunities for youth to disclose high-fidelity sexually transmitted infection (STI) laboratory test result histories to sex partners. Among an online survey sample, we describe latent constructs and other variables associated with perceived behavioral intentions to disclose STI test history using patient portals. Participants were co-ed students aged 18 to 25 years (N = 354) attending a southern United States Historically Black College and University in 2015. Three reliable latent constructs were identified by conducting psychometric analyses on 27 survey items. Latent constructs represent, a) STI test disclosure valuation beliefs, b) communication practices, and c) performance expectancy beliefs for disclosing with patient portals. Multivariable logistic regression was used to estimate the relationship of latent constructs to perceived behavioral intentions to disclose STI test history using patient portals. Approximately 14% (48/354) reported patient portal use prior to study and 59% (208/354) endorsed behavioral intentions to use patient portals to disclose STI test history. The latent construct reflecting performance expectancies of patient portals to improve communication and accuracy of disclosed test information was associated with behavioral intentions to disclose STI test histories using patient portals [adjusted odds ratio (AOR) = 1.15; 95% CI = 1.08 to 1.22; p <0.001]. Latent constructs representing communication valuation beliefs and practices were not associated with intentions. Self-reporting prior STI diagnosis was also associated with intentions to disclose using patient portals (AOR = 2.84; 95% CI = 1.15 to 6.96; p = 0.02). Point of care messages focused on improvements to validating test results, communication, and empowerment, may be an effective strategy to support the adoption of patient portals for STI prevention among populations of college-aged Black youth.

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Section: Resultsmentioning

confidence: 99%

Digital technology to address HIV and other sexually transmitted infection disparities: Intentions to disclose online personal health records to sex partners among students at a historically Black college

et al. 2020

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“…drug use, unprotected sex). Studies using clinical reminders or computer prompts based on HIV risk factors have shown the benefits of this type of intervention, impacting significantly on HIV testing rates [48–53]. A recent initiative in the UK assessed the feasibility of an electronic clinical decision support system, prompting HIV testing based on doctors and nurses selecting certain other tests (e.g.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of an educational intervention to increase HIV-testing in high HIV prevalence general practices: a pilot feasibility stepped-wedged randomised controlled trial

et al. 2018

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BackgroundHIV-infected patients often present to primary care several times with HIV-indicator conditions before diagnosis but the opportunity to test by healthcare professionals (HCPs) is frequently missed. Current HIV testing rates in primary care are low and educational interventions to facilitate HCPs to increase testing and awareness of HIV are needed.MethodWe implemented a pilot feasibility stepped-wedged randomised controlled trial of an educational intervention in high HIV prevalence practices in Bristol. The training delivered to HCPs including General Practitioners (GP) aimed to increase HIV testing and included why, who, and how to test. The intervention was adapted from the Medical Foundation for HIV and Sexual Health HIV Testing in Practice (MEDFASH) educational tool. Questionnaires assessed HCP feedback and perceived impacts of the intervention. HIV testing rates were compared between control and intervention practices using 12 monthly laboratory totals.Results169 HCPs (from 19 practices) received the educational intervention. 127 (75%) questionnaires were completed. Delivery of the intervention was received positively and was perceived as valuable for increasing awareness, confidence and consideration of testing, with HCPs gaining more awareness of HIV testing guidelines. The main pre-training HIV testing barrier reported by GPs was the patient not considering themselves at risk, whilst for nurses it was a concern about embarrassing or offending the patient. Most HCPs reported the intervention addressed these barriers. The HIV testing rate increased more in the control than in the intervention practices: mean difference 2.6 (95% CI 0.5,4.7) compared with 1.9 (− 0.5,4.3) per 1000 patients, respectively. The number of HIV tests across all practices increased from 1154 in the first 6 months to 1299 in the second 6 months, an annual increase in testing rate of 2.0 (0.7,3.4) from 16.3 to 18.3 per 1000 patients.ConclusionThere was a small increase in HIV testing rates over the study period, but this could not be attributed to the educational intervention. More effective and sustainable programmes tailored to each practice context are needed to change testing culture and HCP behaviour. Repeated training, supported by additional measures, such as testing prompts, may be needed to influence primary care HIV testing.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0880-9) contains supplementary material, which is available to authorized users.

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“…An electronic prompt almost doubled the rates of universal HIV screening by primary care providers in a Midwest practice in the USA and reduced racial disparities 29. Federman et al added a reminder to the medical records within the Veterans Affairs healthcare system in the USA based on the risk factors for HIV, leading to an increase in testing of 369% 12.…”

Section: Discussionmentioning

confidence: 99%

Indicator condition-guided HIV testing with an electronic prompt in primary healthcare: a before and after evaluation of an intervention

Redondo¹,

Ruíz²,

Kostov

et al. 2019

Sex Transm Infect

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ObjectiveIndicator condition (IC)-guided HIV testing is a strategy for the diagnosis of patients with HIV. The aim of this study was to assess the impact on the proportion of HIV tests requested after the introduction of an electronic prompt instructing primary healthcare (PHC) physicians to request an HIV test when diagnosing predefined IC.MethodsA prospective interventional study was conducted in 2015 in three PHC centres in Barcelona to assess the number of HIV test requests made during the implementation of an electronic prompt. Patients aged 18–65 years without HIV infection and with a new diagnosis of predefined IC were included. The results were compared with preprompt (2013) and postprompt data (2016).ResultsDuring the prompt period, 832 patients presented an IC (median age 41.6 years [IQR 30–54], 48.2% female). HIV tests were requested in 296 individuals (35, 6%) and blood tests made in 238. Four HIV infections were diagnosed (positivity rate 1.7%, 95% CI 0.5% to 4.4%). The number of HIV tests requested based on IC increased from 12.6% in 2013 to 35.6% in 2015 (p<0.001) and fell to 17.9% after removal of the prompt in 2016 (p<0.001). Younger patient age (OR 0.97, 95% CI 0.96 to 0.98), birth outside Spain (OR 1.53, 95% CI 1.06 to 2.21) and younger physician age (OR 0.97, 95% CI 0.96 to 0.99) were independent predictive factors for an HIV test request during the prompt period. The electronic prompt (OR 3.36, 95% CI 2.70 to 4.18) was the factor most closely associated with HIV test requests. It was estimated that 10 (95% CI 3.0 to 26.2) additional new cases would have been diagnosed if an HIV test had been performed in all patients presenting an IC.ConclusionsA significant increase in HIV test requests was observed during the implementation of the electronic prompt. The results suggest that this strategy could be useful in increasing IC-guided HIV testing in PHC centres.

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Assessment and improvement of HIV screening rates in a Midwest primary care practice using an electronic clinical decision support system: a quality improvement study

Cited by 26 publications

References 41 publications

Digital technology to address HIV and other sexually transmitted infection disparities: Intentions to disclose online personal health records to sex partners among students at a historically Black college

Digital technology to address HIV and other sexually transmitted infection disparities: Intentions to disclose online personal health records to sex partners among students at a historically Black college

Evaluation of an educational intervention to increase HIV-testing in high HIV prevalence general practices: a pilot feasibility stepped-wedged randomised controlled trial

Indicator condition-guided HIV testing with an electronic prompt in primary healthcare: a before and after evaluation of an intervention

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