HIV Provider Documentation and Actions Following Patient Reports of At-risk Behaviors and Conditions When Identified by a Web-Based Point-of-Care Assessment
HIV Provider Documentation and Actions Following Patient Reports of At-risk Behaviors and Conditions When Identified by a Web-Based Point-of-Care Assessment
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DOI：
10.1007/s10461-017-1718-5
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发表时间：
2017-11-01
影响因子：
4.4
通讯作者：
Fredericksen, Rob J.
中科院分区：
文献类型：
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作者：
Crane, Heidi M.;Crane, Paul K.;Fredericksen, Rob J.
我们比较了当天提供者的医疗记录文件和干预措施，以解决抑郁症和风险行为之前和之后提供床旁病人报告的结果（PRO）反馈的患者谁自我报告的临床相关水平的抑郁症或风险行为。在研究期间（2006年1月1日至2010年10月15日），HIV感染患者完成了2289项PRO评估。比较反馈实施前后的8个月，提供者更有可能记录抑郁症（反馈前为74%，反馈后为87%，p = 0.02）（n = 317次评估），有风险的酒精使用（41 vs. 64%，p = 0.04，n = 155）和物质使用（60 vs. 80%，p = 0.004，n = 212）。在反馈后依从性不足的患者中，提供者不太可能错误地记录良好的依从性（42 vs. 24%，p = 0.02，n = 205）。虽然PRO反馈的抑郁症和依从性，其次是增加供应商的干预，其他领域没有。需要进一步调查与认识和干预之间的差距有关的因素，以弥合这一鸿沟。
We compared same-day provider medical record documentation and interventions addressing depression and risk behaviors before and after delivering point-of-care patient-reported outcomes (PROs) feedback for patients who self-reported clinically relevant levels of depression or risk behaviors. During the study period (1 January 2006-15 October 2010), 2289 PRO assessments were completed by HIV-infected patients. Comparing the 8 months before versus after feedback implementation, providers were more likely to document depression (74% before vs. 87% after feedback, p = 0.02) in patients with moderate-to-severe depression (n = 317 assessments), at-risk alcohol use (41 vs. 64%, p = 0.04, n = 155) and substance use (60 vs. 80%, p = 0.004, n = 212). Providers were less likely to incorrectly document good adherence among patients with inadequate adherence after feedback (42 vs. 24%, p = 0.02, n = 205). While PRO feedback of depression and adherence were followed by increased provider intervention, other domains were not. Further investigation of factors associated with the gap between awareness and intervention are needed in order to bridge this divide.