Increases in HIV screening in primary care clinics through an electronic reminder: an interrupted time series

Avery, Ann; Toro, Michelle Del; Caron, Aleece

doi:10.1136/bmjqs-2012-001775

Cited by 28 publications

(27 citation statements)

References 20 publications

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“…Study results showed a two-fold increase in overall testing after reminder implementation. These results support the findings of a study from Case Western Reserve University, which showed that a passive EMR reminder decreased the number of patients never tested for HIV, as well as findings from a study at the Veterans’ Administration (VA) system, which showed increased HIV screening after implementation of a comprehensive intervention that included an active electronic reminder [ 10 , 11 ]. An Indian Health Service survey also found that having an electronic reminder in place for more than one year was correlated with higher levels of HIV screening [ 12 ].…”

Section: Discussionsupporting

confidence: 84%

“…However, a relative strength of our study is the increase in screening it achieved without any of the other time- or resource-intensive interventions described in other positive EMR reminder studies, including provider education [ 11 ], academic detailing and use of champions [ 10 ]. Indeed, our study shows a similar proportional rise in screening to at least one prior study [ 10 ] which was much more resource-intensive.…”

Section: Discussionmentioning

confidence: 99%

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Use of an electronic medical record reminder improves HIV screening

Kershaw

Taylor

Horowitz

et al. 2018

BMC Health Serv Res

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BackgroundMore than 1 in 7 patients with human immunodeficiency virus (HIV) infection in the United States are unaware of their serostatus despite recommendations of US agencies that all adults through age 65 be screened for HIV at least once. To facilitate universal screening, an electronic medical record (EMR) reminder was created for our primary care practice. Screening rates before and after implementation were assessed to determine the impact of the reminder on screening rates.MethodsA retrospective cohort analysis was performed for patients age 18–65 with visits between January 1, 2012-October 30, 2014. EMR databases were examined for HIV testing and selected patient characteristics. We evaluated the probability of HIV screening in unscreened patients before and after the reminder and used a multivariable generalized linear model to test the association between likelihood of HIV testing and specific patient characteristics.ResultsPrior to the reminder, the probability of receiving an HIV test for previously unscreened patients was 15.3%. This increased to 30.7% after the reminder (RR 2.02, CI 1.95–2.09, p < 0.0001). The impact was most significant in patients age 45–65. White race, English as primary language, and higher median household income were associated with lower likelihoods of screening both before and after implementation (RR 0.68, CI 0.65–0.72; RR 0.74, CI 0.67–0.82; RR 0.84, CI 0.80–0.88, respectively).ConclusionsThe EMR reminder increased rates of HIV screening twofold in our practice. It was most effective in increasing screening rates in older patients. Patients who were white, English-speaking, and had higher incomes were less likely to be screened for HIV both before and after the reminder.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Use of an electronic medical record reminder improves HIV screening

Kershaw

Taylor

Horowitz

et al. 2018

BMC Health Serv Res

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“…Processes that depersonalise testing and makes the patient think "that it is offered to all" facilitate and encourage individuals to test and improve testing rates. In this context, the use of electronic flagging on GP computer systems to indicate when a patient should be offered a test could be useful [82]. Such an approach would help to eliminate the perceived view that a judgement is being made by the HCP about an individual's sexuality or race, or that they have been singled out.…”

Section: Discussionmentioning

confidence: 99%

Public and Healthcare Practitioner Attitudes towards HIV Testing: Review of Evidence from the United Kingdom (UK)

Davies

Gompels

May

2015

ISRR

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Aims:To explore attitudes towards HIV testing in the United Kingdom (UK) from the public and healthcare practitioners (HCP) to more fully understand the barriers and motivators towards testing. Methodology: Electronic databases Pubmed, Web of Science, OVID Medline and Google were searched. We included studies conducted in the UK that had explored public and HCP attitudes towards HIV testing, published in the combination antiretroviral therapy era (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014). We excluded studies relating to HIV testing or screening of pregnant women. Results: In a total of 64 studies identified, 41 and 23 were on positive and negative attitudes towards HIV testing of the public and HCP, respectively. Common barriers reported by the public Davies et al.; ISRR, 3(3): 91-122, 2015; Article no.ISRR.2015.013 92 were stigma, fear, denial, and low perception of risk. Common barriers reported by HCP were lack of confidence or anxiety around offering a test, privacy and confidentiality, and insufficient knowledge/training in HIV. Public motivators towards testing were: HCP offering/recommending a test, universal testing at practice registration, outreach rapid point-of-care (POC) testing offered as part of a check-up, availability of home testing/sampling, and informing patients about HIV and the benefit of receiving treatment. Conclusions: Recommendations to overcome barriers include making HIV testing routine, easier and more accessible. Outreach POC testing, home testing and sampling offer motivators to testing such as ease of access, privacy and confidentiality. A proactive offer of an HIV test by the HCP is an important factor which could help increase testing rates. This could be facilitated by further education and training of HCP in General Practice. Review Article

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“…However, due to their simplicity and simple rules for detecting non-random patterns and variation over time, the run chart has been described as the 'universal tool' for virtually every improvement project. 11 They have been employed by clinical teams for a wide variety of health care processes such as HIV screening in primary care, 12 for inpatient bronchiolitis, 13 chemotherapy, 14 measuring inpatient harms, 15 central line associated bacteraemia, 16 orthopaedics, 17 acute coronary syndrome, 18 inhaled corticosteroid prescribing, 19 insulin therapy 20 and also by patients. 5,21 At the time of the study, the two PHOs also used run charts to track immunisation and to illustrate progress towards population health priority areas such as giving brief advice for smoking cessation.…”

Section: Discussionmentioning

confidence: 99%

Using run charts for cardiovascular disease risk assessments in general practice

et al. 2016

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1Management recommendations are based on five-year CVD risk stratification, with greater the intensity of lifestyle and medication management recommended for people with higher estimated ABSTRACT IntroductIon: Run charts are quality improvement tools.AIm: To investigate the feasibility and acceptability of run charts displaying weekly cardiovascular disease (CVD) risk assessments in general practice and assess their impact on CVD risk assessments.methods: A controlled non-randomised observational study in nine practices using run charts and nine control practices. We measured the weekly proportion of eligible patients with completed CVD risk assessments for 19 weeks before and after run charts were introduced into intervention practices. A random coefficients model determined changes in CVD risk assessment rates (slope) from pre-to post-intervention by aggregating and comparing intervention and control practices' mean slopes. We interviewed staff in intervention practices about their use of run charts.results: Seven intervention practices used their run chart; six consistently plotting weekly data for >12 weeks and positioning charts in a highly visible place. Staff reported that charts were easy to use, a visual reminder for ongoing team efforts, and useful for measuring progress. There were no significant differences between study groups: the mean difference in pre-to post-run chart slope in the intervention group was 0.03% more CVD risk assessments per week; for the control group the mean difference was 0.07%. The between group difference was 0.04% per week (95% CI: -0.26 to 0.35, P = 0.77).dIscussIon: Run charts are feasible in everyday general practice and support team processes. There were no differences in CVD risk assessment between the two groups, likely due to national targets driving performance at the time of the study.

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Increases in HIV screening in primary care clinics through an electronic reminder: an interrupted time series

Abstract: Implementing an electronic medical record-based reminder effectively increased HIV testing among primary care patients not previously tested, while education and practice feedback alone did not.

Cited by 28 publications

References 20 publications

Use of an electronic medical record reminder improves HIV screening

Use of an electronic medical record reminder improves HIV screening

Public and Healthcare Practitioner Attitudes towards HIV Testing: Review of Evidence from the United Kingdom (UK)

Using run charts for cardiovascular disease risk assessments in general practice

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