Information systems for patient follow-up and chronic management of HIV and tuberculosis: a life-saving technology in resource-poor areas.
Information systems for patient follow-up and chronic management of HIV and tuberculosis: a life-saving technology in resource-poor areas.
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DOI：
10.2196/jmir.9.4.e29
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发表时间：
2007-10-22
影响因子：
7.4
通讯作者：
Blaya J
中科院分区：
文献类型：
--
作者：
Fraser HS;Allen C;Bailey C;Douglas G;Shin S;Blaya J
在发展中国家扩大对艾滋病毒和耐多药结核病(耐多药结核病)的治疗需要与患者建立长期关系、准确和可获取的每个患者的病史记录以及跟踪其进展情况的方法。最近的研究表明，在非洲，艾滋病毒患者在治疗期间失去了高达24%的随访，许多患者根本没有开始治疗。一些预防母婴传播的项目对艾滋病毒阳性母亲所生婴儿的随访损失超过80%。如果这些患者的抗逆转录病毒治疗中断，他们面临死亡或产生抗药性的巨大风险。在扩大耐多药结核病治疗的过程中也发现了类似的问题。这项研究的目的是评估医疗信息系统在跟踪艾滋病毒或耐多药结核病患者方面的作用，确保他们迅速开始高质量的护理，并减少后续行动的损失。从之前的综述开始，使用Medline和谷歌学者进行文献搜索。由于这项工作的性质以及到目前为止发表的文章相对较少，作者还依赖于个人对正在使用的系统的知识和经验以及他们自己对系统的评估。非洲和拉丁美洲的六个艾滋病毒和耐多药结核病治疗项目描述了跟踪患者和检测失去后续行动的患者的功能。初步数据显示，跟踪那些没有开出适当药物的患者、那些没有回来进行随访的患者以及那些没有得到医护人员为他们取来的药物的患者，是有好处的。提供关键实验室数据以及利用这些数据提高护理的及时性和质量也有好处。随访通常是通过信息系统和社区卫生保健工作者团队的报告相结合实现的。低成本卫星互联网接入、个人数字助理和手机等新技术正在帮助扩大这些系统的覆盖范围。发展中国家的有效信息系统是最近的一项创新，但在艾滋病毒和耐多药结核病项目从数千名患者扩大到数十万名患者时，需要在支持和监测这些项目方面发挥越来越大的作用。应特别注重跟踪患者从最初诊断到开始有效治疗的过程，然后监测他们的治疗中断或丢失以进行后续治疗。需要对电子信息系统对跟踪患者的影响进行更多的量化评估。
The scale-up of treatment for HIV and multidrug-resistant tuberculosis (MDR-TB) in developing countries requires a long-term relationship with the patient, accurate and accessible records of each patient’s history, and methods to track his/her progress. Recent studies have shown up to 24% loss to follow-up of HIV patients in Africa during treatment and many patients not being started on treatment at all. Some programs for prevention of maternal–child transmission have more than 80% loss to follow-up of babies born to HIV-positive mothers. These patients are at great risk of dying or developing drug resistance if their antiretroviral therapy is interrupted. Similar problems have been found in the scale-up of MDR-TB treatment. The aim of the study was to assess the role of medical information systems in tracking patients with HIV or MDR-TB, ensuring they are promptly started on high quality care, and reducing loss to follow-up. A literature search was conducted starting from a previous review and using Medline and Google Scholar. Due to the nature of this work and the relative lack of published articles to date, the authors also relied on personal knowledge and experience of systems in use and their own assessments of systems. Functionality for tracking patients and detecting those lost to follow-up is described in six HIV and MDR-TB treatment projects in Africa and Latin America. Preliminary data show benefits in tracking patients who have not been prescribed appropriate drugs, those who fail to return for follow-up, and those who do not have medications picked up for them by health care workers. There were also benefits seen in providing access to key laboratory data and in using this data to improve the timeliness and quality of care. Follow-up was typically achieved by a combination of reports from information systems along with teams of community health care workers. New technologies such as low-cost satellite Internet access, personal digital assistants, and cell phones are helping to expand the reach of these systems. Effective information systems in developing countries are a recent innovation but will need to play an increasing role in supporting and monitoring HIV and MDR-TB projects as they scale up from thousands to hundreds of thousands of patients. A particular focus should be placed on tracking patients from initial diagnosis to initiation of effective treatment and then monitoring them for treatment breaks or loss to follow-up. More quantitative evaluations need to be performed on the impact of electronic information systems on tracking patients.
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影响因子：
3.8
作者：
Morgan, D;Mahe, C;Whitworth, JAG
通讯作者：
Whitworth, JAG
影响因子：
105.7
作者：
Fraser, HSF;Jazayeri, D;Mukherjee, JS
通讯作者：
Mukherjee, JS
影响因子：
3.8
作者：
Coetzee, D;Hildebrand, K;Goemaere, E
通讯作者：
Goemaere, E
DOI：
10.1197/jamia.m1353
发表时间：
2003-11-01
影响因子：
6.4
作者：
Hoch, I;Heymann, AD;Shalev, V
通讯作者：
Shalev, V
影响因子：
3.8
作者：
Glynn, Judith R.;Sonnenberg, Pam;Murray, Jill
通讯作者：
Murray, Jill