Chronic Care Model Decision Support and Clinical Information Systems Interventions for People Living with HIV: A Systematic Review

Pasricha, Anjori; Deinstadt, Roo T. M.; Moher, David; Killoran, Amanda; Rourke, Sean B.; Kendall, Claire

doi:10.1007/s11606-012-2145-y

Cited by 30 publications

(38 citation statements)

References 39 publications

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“…Four reviews included two comparisons each (Dudley 2011; Hansen 2011; Pasricha 2012; Young 2010), and another three reviews, three comparisons each (Butler 2011; Handford 2006; Theodoratou 2010), so the total number of comparisons evaluated in the 51 included reviews was 60 (Appendix 3 provides details of interventions and comparisons).…”

Section: Resultsmentioning

confidence: 99%

“…A review of the effects of decision support and clinical information systems on healthcare processes and health outcomes for people with HIV included a total of 16 trials (Pasricha 2012). Clinical information-system interventions were defined as information systems to organise patient data in order to improve the delivery of care, for example by developing schedules for patients with certain conditions, audit and feedback, change in medical records systems or reminders.…”

Section: Resultsmentioning

confidence: 99%

“…A review examined the effects of decision support systems, with or without clinical information systems, on healthcare processes and health outcomes, compared to usual care or non-chronic models of care (Pasricha 2012). Decision support (with or without clinical information systems) may improve health professionals' adherence to recommended practice and patients' adherence to treatment (low-certainty evidence).…”

Section: Resultsmentioning

confidence: 99%

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Delivery arrangements for health systems in low-income countries: an overview of systematic reviews

Ciapponi

Lewin

Herrera

et al. 2017

Cochrane Database of Systematic Reviews

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BackgroundDelivery arrangements include changes in who receives care and when, who provides care, the working conditions of those who provide care, coordination of care amongst different providers, where care is provided, the use of information and communication technology to deliver care, and quality and safety systems. How services are delivered can have impacts on the effectiveness, efficiency and equity of health systems. This broad overview of the findings of systematic reviews can help policymakers and other stakeholders identify strategies for addressing problems and improve the delivery of services.ObjectivesTo provide an overview of the available evidence from up-to-date systematic reviews about the effects of delivery arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on delivery arrangements and informing refinements of the framework for delivery arrangements outlined in the review.MethodsWe searched Health Systems Evidence in November 2010 and PDQ-Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of delivery arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use, healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty or employment) and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the findings. Two overview authors independently screened reviews, extracted data, and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence), and assessments of the relevance of findings to low-income countries.Main resultsWe identified 7272 systematic reviews and included 51 of them in this overview. We judged 6 of the 51 reviews to have important methodological limitations and the other 45 to have only minor limitations. We grouped delivery arrangements into eight categories. Some reviews provided more than one comparison and were in more than one category. Across these categories, the following intervention were effective; that is, they have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects.Who receives care and when: queuing strategies and antenatal care to groups of mothers.Who provides care: lay health workers for caring for people with hypertension, lay health workers to deliver care for mothers and children or infectious diseases, lay health workers to deliver community-based neonatal care packages, midlevel health professionals for abortion care, social support to pregnant women at risk, midwife-led c...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Delivery arrangements for health systems in low-income countries: an overview of systematic reviews

Ciapponi

Lewin

Herrera

et al. 2017

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

show abstract

“…Physiciandirected interventions may be required, as physicians may emphasize the provision of HIV-specific primary care services to the detriment of routine, non-HIV-specific health screening, such as mammography. 12,31,32 This phenomenon may be related in part to the time constraints associated with the management of HIV and associated comorbidities. 33,34 These findings have implications for HIV care practice and policy, which must increasingly encompass the prevention and management of comorbidities across the lifespan and requires communication and integration across primary and specialist care.…”

Section: Resultsmentioning

confidence: 99%

A cross-sectional population-based study of breast cancer screening among women with HIV in Ontario, Canada

et al. 2017

Self Cite

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Background:As women with HIV live longer, the need for age-appropriate breast cancer screening will increase. We compared rates of screening mammography among women with and without HIV. Methods:We used administrative health databases to identify all women in Ontario, Canada, who were eligible for screening mammography (aged 50 to 74 yr and no history of breast cancer) as of Apr. 1, 2011. We used multivariable log-binomial regression to compare the 2-year period prevalence of screening mammography in 2011 to 2013 among women with and without HIV and to examine the correlates of screening among women with HIV. Canada, and identify correlates of screening using large provincial administrative databases.

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“…We recommend that such access to HIV expertise, whether through direct contact with HIV specialists or through strategies that give decision support to family physicians, be provided within a collaborative model that allows patients to retain continuity with their family physicians to ensure a comprehensive approach to care delivery. 19,[40][41][42] …”

Section: Discussionmentioning

confidence: 99%

A Population-Based Study Evaluating Family Physicians' HIV Experience and Care of People Living With HIV in Ontario

Kendall

Dujovny

Younger

et al. 2015

The Annals of Family Medicine

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PURPOSE Greater physician experience managing human immunodeficiency virus (HIV) infection has been associated with better HIV-specific outcomes. The objective of this study was to evaluate whether the HIV experience of a family physician modifies the association between the model of care delivery and the quality of care for people living with HIV. METHODSWe retrospectively analyzed data from a population-based observational study conducted between April 1, 2009, and March 31, 2012. A total of 13,417 patients with HIV in Ontario were stratified into 5 possible patterns or models of care. We used multivariable hierarchical logistic regression analyses, adjusted for patient characteristics and pairwise comparisons, to evaluate the modification of the association between care model and indicators of quality of care (receipt of antiretroviral therapy, cancer screening, and health care use) by level of physician HIV experience (≤5, 6-49, ≥50 patients during study period). RESULTSThe majority of HIV-positive patients (52.8%) saw family physicians exclusively for their care. Among these patients, receipt of antiretroviral therapy was significantly lower for those receiving care from family physicians with 5 or fewer patients and 6-49 patients compared with those with 50 or more patients CONCLUSIONS Family physician HIV experience was strongly associated with receipt of antiretroviral therapy by HIV-positive patients, especially among those seeing only family physicians for their care. Future work must determine the best models for integrating and delivering comprehensive HIV care among diverse populations and settings. Ann Fam Med 2015;13:436-445. doi: 10.1370/afm.1822. INTRODUCTIONA ntiretroviral therapy (ART) has substantially reduced the mortality and morbidity arising from human immunodeficiency virus (HIV) infection, thus shifting the care needs of people living with longstanding HIV. Evidence suggests that clinicians with more HIV training, HIV experience, or both provide higher quality of care as measured by disease-specific indicators, including ART prescribing. [1][2][3][4][5][6] Many of these studies, however, were performed early in the ART era, when both disease and treatments were novel and complex. Recent work has found similar quality of HIV-specific care between generalist and specialist physicians, even though the HIV experience of these physicians varied. 7,8 In addition, multidisciplinary care teams with nonexpert family physicians may improve patients' ART adherence more than HIV specialist care alone. 9 Another important consideration is that specialist HIV physicians are less adept than generalists at preventing and managing the common comorbidities emerging with increased HIV longevity. [10][11][12][13][14][15][16][17][18] increasing recognition that the management of HIV requires a primary care presence, but we have a poor understanding of how to integrate HIV-specific expertise within a primary care context. 7,10,[14][15][16][17][18][19][20][21] Overall, it has been difficult to distin...

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Chronic Care Model Decision Support and Clinical Information Systems Interventions for People Living with HIV: A Systematic Review

Cited by 30 publications

References 39 publications

Delivery arrangements for health systems in low-income countries: an overview of systematic reviews

Delivery arrangements for health systems in low-income countries: an overview of systematic reviews

A cross-sectional population-based study of breast cancer screening among women with HIV in Ontario, Canada

A Population-Based Study Evaluating Family Physicians' HIV Experience and Care of People Living With HIV in Ontario

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