Under-documentation of psychiatric diagnoses among persons living with HIV in electronic medical records
Under-documentation of psychiatric diagnoses among persons living with HIV in electronic medical records
复制标题
DOI：
10.1080/09540121.2020.1713974
复制
发表时间：
2020-01-15
影响因子：
1.7
通讯作者：
Blank, Michael B.
中科院分区：
文献类型：
--
作者：
Brown, Lily A.;Mu, Wenting;Blank, Michael B.
与一般人群相比，艾滋病毒感染者（PLWH）明显更有可能符合精神障碍的标准。据我们所知，之前没有研究报告PLWH的电子病历（emr）中精神病诊断文件的比率。本研究的目的是在电子病历中报告PLWH中各种精神病诊断的比率。参与者（n = 2336）被纳入宾夕法尼亚州费城宾夕法尼亚大学艾滋病研究中心（CFAR）纵向数据库研究。从EMR中提取抑郁症、酒精和物质使用障碍、创伤后应激障碍、睡眠障碍和适应障碍的诊断代码，并与国家流行病学研究的比率进行比较。EMR中重度抑郁症的发生率与之前关于hiv感染样本的报告相当。相比之下，EMR中创伤后应激障碍、物质使用障碍、酒精使用障碍、适应障碍和失眠的比率都明显低于hiv感染样本的国家估计。当临床医生恰当地记录重度抑郁症的证据时，其他精神疾病的合并症在很大程度上被忽视了。这些发现表明，临床医生在如何检测或记录PLWH患者的精神疾病方面存在潜在的偏见。
Persons living with HIV (PLWH) are significantly more likely to meet criteria for a psychiatric disorder compared to the general population. To our knowledge there are no prior studies that report rates of psychiatric diagnosis documentation in electronic medical records (EMRs) of PLWH. The goal for this study was to report the rates of a variety of psychiatric diagnoses among PLWH in electronic medical records. Participants (n = 2,336) were enrolled in the Center for AIDS Research (CFAR) Longitudinal Database study at the University of Pennsylvania, Philadelphia, PA. Diagnostic codes were extracted from the EMR for depressive disorders, alcohol and substance use disorders, PTSD, sleep disorders, and adjustment disorders and were compared to rates from national epidemiological studies. Rates of Major Depressive Disorder in the EMR were comparable to prior reports on HIV-infected samples. In contrast, rates of PTSD, substance use disorders, alcohol use disorders, adjustment disorders and insomnia from the EMR were all markedly lower compared to national estimates for HIV-infected samples. While clinicians appropriately documented evidence of Major Depressive Disorder, other psychiatric comorbidities were largely overlooked. These findings suggest a potential bias in how clinicians either detect or document psychiatric disorders in PLWH.