Electronic Human Immunodeficiency Virus (HIV) Clinical Reminder System Improves Adherence to Practice Guidelines among the University of Washington HIV Study Cohort

Abstract

We conducted a prospective study of an electronic clinical reminder system in an academic medical center-based human immunodeficiency virus (HIV) specialty clinic. Published performance indicators were used to examine adherence to HIV practice guidelines before and after its implementation for 1204 patients. More than 90% of patients received CD4 cell count and HIV type 1 (HIV-1) RNA level monitoring every 3–6 months during both time periods, and ∼80% of patients with a CD4 cell count nadir of 3 received highly active antiretroviral therapy. Patients were significantly more likely to receive prophylaxis against Mycobacterium avium complex (hazard ratio, 3.84; 95% confidence interval [CI], 1.58–9.31; P =.003), to undergo annual cervical carcinoma screening (OR, 2.09; 95% CI, 1.04–4.16; P =.04), and to undergo serological screening for Toxoplasma gondii (odds ratio [OR], 1.86; 95% CI, 1.05–3.27; P =.03) and syphilis infection (OR, 3.71; 95% CI, 2.37–5.81; P <.0001). HIV clinical reminders delivered at the time that HIV care is provided were associated with more timely initiation of recommended practices.