Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #113534

Beulah Perdue Sabundayo, PharmD, MPH¹, Zubin Dastur, MS, MPH², Greg Lucas, MD, MPH³, Bruce R. Shackman, PhD², and Richard Moore, MD³. (1) School of Medicine, Johns Hopkins University, 1830 East Monument Street, Room 8016, Baltimore, MD 21287, 443 287-6404, bsabund1@jhmi.edu, (2) Weill Medical College, Cornell University, 139-26 Booth Memorial Avenue, 2nd Floor, Flushing, NY 11355, (3) Johns Hopkins University School of Medicine, 1830 East Monument Street, Rm. 40, Baltimore, MD 21287

Relevance: Audio computer-assisted self-interview (ACASI) is a technology that has been shown to provide more valid data than face-to-face interviews on sensitive behaviors. Our ACASIs are designed to enhance care in areas where patient participation is a key determinant of quality and outcomes: medication adherence, side effects, and referrals for substance abuse, psychiatric, and other care. We hypothesize that ACASI feedback will improve provider-patient communication, facilitate early identification of poor adherence and problems that affect adherence, and promote timely interventions.

Intervention/Evaluation: ACASI questionnaires are completed by patients prior to visits with their care providers at 3 urban HIV clinics: 1 in Baltimore (Johns Hopkins University) and 2 in New York City (Weill Medical College of Cornell University). In Baltimore, subjects are randomized to have ACASI summaries immediately relayed to providers or have summaries remain confidential. In New York, all subjects have ACASI summaries relayed to their providers. Patient comfort with ACASI is assessed at baseline and throughout the intervention.

Initial Findings: Since April 2003, 166 patients (58% male, 85% African American) have completed 789 ACASIs at the Baltimore site. The mean age is 43 years (range: 25 -66 years) and 23% are naïve to therapy. Baseline surveys were completed by 137 patients. Most patients (84%) were very comfortable answering questions on the computer and a majority (63%) felt it was easier to tell information to a computer as opposed to their provider. Almost half (45%) thought answering questions on the computer made them think of things to discuss with their providers. For those who had answers given to their providers, most (76%) felt that ACASI was very helpful in facilitating communication with their providers. As of January 2005, 141 patients (82% male, 71% Latino/a) completed 326 ACASIs (49% in Spanish) at the New York sites. The mean age is 44 years (range: 24 - 68 years). At baseline, nearly 80% of patients were “very comfortable” answering questions on the computer and one-third felt it was easier to tell information to a computer. Almost 70% thought answering ACASI questions made them think of things to discuss with their providers.

Our collective, initial findings indicate that patients are comfortable with ACASI and that use of this technology in a clinic setting improves patient-provider communication. Outcomes that are being evaluated include self-reported adherence, referrals by providers, HIV-1 RNA suppression and CD4 change at 6 and 12 months, duration of HAART, and HIV resistance.

Learning Objectives: Following this presenation, attendees will be able to

• describe how audio computer-assisted self-interviews (ACASI) can be used in an urban clinic population to improve provider-patient communication;
• identify two evaluation approaches to assessing the feasibility and effectivenss of using an ACASI in this population; and
• discuss patients' attitudes about and experiences of completing an ACASI in an urban clinic setting.

Keywords: Information Technology, Quality Improvement

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.