244467 Impact of same-day pre-visit electronic Patient-Reported Outcome (PRO) collection on provider assessment of sexual risk and other behaviors of HIV-Infected patients in routine clinical care

Wednesday, November 2, 2011

Rob Fredericksen, PhD, MPH , Center for AIDS Research, University of Washington, Seattle, WA
Paul Crane, MD , Internal Medicine, University of Washington, Seattle, WA
Betsy Feldman, PhD , Center for AIDS Research, University of Washington, Seattle, WA
James Tufano, PhD , Medical Education, University of Washington, Seattle, WA
Robert Harrington, MD , Allergy & Infectious Diseases, University of Washington, Seattle, WA
Shireesha Dhanireddy, MD , Dept of Allergy & Infectious Diseases, University of Washington, Seattle, WA
Thomas Davis, MA , Center for AIDS Research, University of Washington, Seattle, WA
Tyler Brown, BA , Center for AIDS Research, University of Washington, Seattle, WA
Mari Kitahata, MD , Center for AIDS Research, University of Washington, Seattle, WA
Heidi Crane, MD MPH , Center for AIDS Research, University of Washington, Seattle, WA
Background: This study examines the impact of same-day PRO reports to providers on chart documentation of provider awareness and behavior. Methods: In an HIV clinic, patients complete electronic PRO assessments immediately before their visit, reporting recent sexual intercourse without condoms, missing antiretroviral doses in the last 4 days, AUDIT-C scores, and PHQ-9 scores >10, identified patients with at-risk sexual behavior, inadequate adherence, at-risk alcohol use, and moderate-to-severe depression respectively. Providers receive the report before entering the patient's examination room. Chart reviewers, blinded to whether providers received PRO reports, reviewed same-day provider documentation regarding awareness and actions of these 4 domains occurring within 8 months before and after initiation of provider reports. Results: Among 166 patients reporting at-risk sexual behavior, no differences were present in provider documentation of at-risk sex before vs. after PRO reports. Among 205 patients with inadequate adherence, providers documented incorrect adherence assessments (“perfect adherence”, “missed no doses”) in 24% after vs. 42% before reports (p=0.02). Among 156 patients with at-risk alcohol use, 64% of provider documentation acknowledged alcohol use after vs. 42% before reports (p=0.04). Providers documented some action in response to alcohol (e.g. health educator referral) in 29% after vs. 13% before reports (p=0.09). Among 317 patients with moderate-to-severe depression, 87% of provider documentation acknowledged depression after vs. 74% prior to reports (p=0.02). Conclusions: PRO collection increases accuracy of adherence assessments, awareness of at-risk alcohol use, and identification of moderate-to-severe depression. Further efforts are needed to increase provider identification of risk behavior, particularly at-risk sexual behavior.

Learning Areas:
Chronic disease management and prevention
Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
Describe the impact of same-day, pre-visit patient reported outcome collection on HIV care providers' assessment of sexual risk behavior, HAART medication adherence, moderate-to-severe depression, and alcohol use among HIV-infected patients. Discuss potential role of electronic PRO collection in improving care and health outcomes for persons living with HIV/AIDS.

Keywords: HIV Risk Behavior, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a PhD/MPH level research scientist with 3+ years experience in PRO collection and analysis. I have 9+ years experience working with HIV-infected populations in the U.S.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Novel Approaches to HIV/AIDS Research
See more of: HIV/AIDS