Choice architecture-based prescribing tool for TB preventive therapy: a pilot study in South Africa

Abstract

Background: All people with HIV who screen negative for active tuberculosis (TB) should receive isoniazid preventive therapy (IPT). IPT implementation remains substantially below the 90% WHO target. This study sought to further understanding of IPT prescription by piloting a simplified prescribing approach.Setting: Primary care clinics in Matlosana, South Africa.Design: This was a mixed-methods implementation study.Methods: Nine providers were recruited and underwent training on 2018 WHO guidelines. A simplified prescribing tool containing antiretroviral therapy (ART) and IPT prescriptions was introduced into the workflow for 2 weeks. Prescription data were collected from file review. Interviews were conducted with prescribers.Results: During the study period, 41 patients were evaluated for ART initiation; 34 (83%) files used the simplified prescribing tool. Thirty-seven (90%) patients were eligible for same-day ART and IPT initiation, of whom 36 (97%) received IPT prescription. Qualitative interviews identified the following barriers to IPT prescription: cognitive burden, extensive documentation, limited management support, paucity of training, stock-outs, and patient-related factors. Provider acceptability of the tool was favorable, with unanimous recommendation to colleagues on the basis of streamlining documentation and reminding to prescribe.Conclusions: This simplified prescribing device for IPT was feasible to implement. Streamlining documentation and reminding providers to prescribe can reduce work-flow barriers to IPT provision.

Workload and workflow implications associated with the use of electronic clinical decision support tools used by health professionals in general practice: a scoping review

“…The six articles that reported a perceived decrease in consultation duration suggested explanations which included reduced need for data entry [ 62 , 81 , 98 ], synchronisation with the usual workflow of decision-making [ 118 ] and saving time when discussing risk management of specific conditions during the consultation [ 67 , 68 ]. In terms of the purpose, feature and functionality of the studied eCDS tools, the articles referred mainly to tools that were seen to improve efficiency, four of which featured a tool designed to support clinicians in the management of conditions, rather than on their diagnosis.…”

“…Qualitative interview data suggested that clinicians felt an eCDS tool for prescribing tuberculosis preventive therapy decreased their cognitive workload during consultations. [ 98 ] This was perceived as advantageous as it reduced the amount of time spent documenting medications and their contraindications. However, in two articles, eCDS tools were noted to increase cognitive workload.…”

Workload And Workflow Implications Associated With The Use Of Electronic Clinical Decision Support Tools Used By Health Professionals In General Practice: A Scoping Review

“…Qualitative interview data suggested that clinicians felt an eCDS tool for prescribing tuberculosis preventive therapy decreased their cognitive workload during consultations. 79 This was perceived as advantageous as it reduced the amount of time spent documenting medications and their contraindications. However, in two studies, eCDS tools were noted to increase cognitive workload.…”

“…The six studies that reported a perceived decrease in consultation duration referred mainly to eCDS tools that were seen to improve e ciency, four of which featured a tool designed to support clinicians in the management of conditions, rather than on their diagnosis. The rationale for reported improvement included reduced need for data entry [77][78][79] , synchronisation with the usual work ow of decision-making 80 and saving time when discussing risk management of speci c conditions during the consultation 58,81 . The tools described within these studies were all either embedded within the EMR system or linked/interacted with the EMR in some way.…”

Effects of Behavioral Economics–Based Messaging on Appointment Scheduling Through Patient Portals and Appointment Completion: Observational Study

“…Over the past decade, these tenets of behavioral economics have been increasingly utilized in health care for both patients (cancer screenings [ 14 ], hospital appointment no-show rates [ 7 ], medication adherence for behavioral health [ 15 ], HIV testing rates [ 16 ], obesity and binge eating [ 17 ]) and clinicians (prescribing behavior [ 18 , 19 ], overtreatment of diabetes [ 20 ]), with 83 publications in the top 3 highest impact general medicine journals (Journal of the American Medical Association, The Lancet, The New England Journal of Medicine) from 1998 to 2018 [ 21 ]. A systematic review [ 22 ] found patient portal interventions to be effective in improving a few psychological outcomes, medication adherence, and preventive service use.…”