Electronic decision protocols for ART patient triaging to expand access to HIV treatment in South Africa: a cross sectional study for development and validation.
Electronic decision protocols for ART patient triaging to expand access to HIV treatment in South Africa: a cross sectional study for development and validation.
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DOI：
10.1016/j.ijmedinf.2011.11.003
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发表时间：
2012-03
影响因子：
4.9
通讯作者：
Lesh N
中科院分区：
文献类型：
--
作者：
Mitchell M;Hedt BL;Eshun-Wilson I;Fraser H;John MA;Menezes C;Grobusch MP;Jackson J;Taljaard J;Lesh N
由于医生和护士的短缺，加上今后向农村诊所的扩展，将要求大多数接受抗逆转录病毒治疗的艾滋病毒感染患者的诊所就诊由非医生管理。这项研究的目的是制定和评估一项筛查方案，以确定哪些患者需要进行全面的临床评估，哪些患者病情稳定，无需医生咨询即可接受药物治疗。在这项研究中，我们开发了一种电子手持工具，通过筛选问题来指导非医师咨询师。2007年3月至2008年4月期间在南非两家ART诊所进行常规随访的患者纳入了我们的研究。每位患者都由非医师顾问使用手持设备进行筛选，然后接受全面的临床评估。临床医生关于是否有必要进行全面临床评估的报告被用作确定“需要转诊”的金标准。观察结果被随机分为两个数据集- 989用于开发转诊协议，200用于验证协议性能。三分之一的患者至少有一种身体不适，16%的患者有五种或更多的身体不适。38%的患者需要转诊进行全面的临床评估。我们确定了一个问题子集，其中敏感性为87%，特异性为47%，用于推荐患者转诊。最终的筛查方案是高度敏感的，可以将抗逆转录病毒治疗临床医生的负担减轻30%。支持协议实现的手持工具的使用率和接受度很高。进一步检查数据揭示了几个重要的问题，包括在未来的转诊算法，以提高敏感性和特异性。基于这些结果，我们确定了一个改进的算法来探索未来的评估。
The shortage of doctors and nurses, along with future expansion into rural clinics, will require that the majority of clinic visits by HIV infected patients on antiretroviral therapy (ART) are managed by non-doctors. The goal of this study was to develop and evaluate a screening protocol to determine which patients needed a full clinical assessment and which patients were stable enough to receive their medications without a doctor’s consultation. For this study, we developed an electronic, handheld tool to guide non-physician counselors through screening questions. Patients visiting two ART clinics in South Africa for routine follow-up visits between March 2007 – April 2008 were included in our study. Each patient was screened by non-physician counselors using the handheld device and then received a full clinical assessment. Clinicians’ report on whether full clinical assessment had been necessary was used as the gold standard for determining “required referral”. Observations were randomly divided into two datasets – 989 for developing a referral protocol and 200 for validating protocol performance. A third of patients had at least one physical complaint, and 16% had five or more physical complaints. 38% of patients required referral for full clinical assessment. We identify a subset of questions which are 87% sensitive and 47% specific for recommended patient referral. The final screening protocol is highly sensitive and could reduce burden on ART clinicians by 30%. The uptake and acceptance of the handheld tool to support implementation of the protocol was high. Further examination of the data reveals several important questions to include in future referral algorithms to improve sensitivity and specificity. Based on these results, we identify a refined algorithm to explore in future evaluations.
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DOI：
10.1197/jamia.m1184
发表时间：
2003-07-01
影响因子：
6.4
作者：
Fraser, HSF;Long, WJ;Naimi, S
通讯作者：
Naimi, S
DOI：
10.4269/ajtmh.2005.72.301
发表时间：
2005-03-01
影响因子：
3.3
作者：
Missinou, MA;Olola, CHO;Kremsner, PG
通讯作者：
Kremsner, PG
DOI：
10.1108/09526869410074702
发表时间：
1994-01-01
影响因子：
1.5
作者：
Heymann, T
通讯作者：
Heymann, T
DOI：
10.1504/ijhtm.2009.025819
发表时间：
2009-01-01
影响因子：
1
作者：
Mitchell, Marc;Lesh, Neal;Wolf, Kate
通讯作者：
Wolf, Kate
影响因子：
168.9
作者：
SAFRAN, C;RIND, DM;COTTON, DJ
通讯作者：
COTTON, DJ