Document 0077
 DOCN  M95B0077
 TI    Guidelines for management of HIV infection with computer-based patient's
       record.
 DT    9511
 AU    Safran C; Rind DM; Davis RB; Ives D; Sands DZ; Currier J; Slack WV;
       Makadon HJ; Cotton DJ; Department of Medicine, Beth Israel Hospital,
       Boston, MA, USA.
 SO    Lancet. 1995 Aug 5;346(8971):341-6. Unique Identifier : AIDSLINE
       MED/95349230
 AB    Computers are steadily being incorporated in clinical practice. We
       conducted a nonrandomised, controlled, prospective trial of electronic
       messages designed to enhance adherence to clinical practice guidelines.
       We studied 126 physicians and nurse practitioners who used electronic
       medical records when caring for 349 patients with HIV infection in a
       primary care practice. We analysed the response times of clinicians to
       the situations that triggered alerts and reminders, the number of
       ambulatory visits, and hospitalisation. The median response times to 303
       alerts in the intervention group and 388 alerts in the control group
       were 11 and 52 days (p < 0.0001), respectively. The median response time
       to 432 reminders in the intervention group was 114 days and that for 360
       reminders in the control group was over 500 days (p < 0.0001). There was
       no effect on visits to the primary care practice. There was, however, a
       significant increase in the rate of visits outside the primary care
       practice (p = 0.02), which is explained by the increased frequency of
       visits to ophthalmologists. There were no differences in admission rates
       (p = 0.47), in admissions for pneumocystosis (p = 0.09), in visits to
       the emergency ward (p = 0.24), or in survival (p = 0.19). We conclude
       that the electronic medical record was effective in helping clinicians
       adhere to practice guidelines.
 DE    Acquired Immunodeficiency Syndrome/MORTALITY/THERAPY  Ambulatory
       Care/UTILIZATION  Boston  CD4 Lymphocyte Count  Emergency Medical
       Services/UTILIZATION  Family Practice  Hospitalization  Human  HIV
       Infections/MORTALITY/*THERAPY  Medical Records Systems,
       Computerized/*UTILIZATION  Patient Care Team/*STANDARDS  *Practice
       Guidelines  Prospective Studies  Regression Analysis  Reminder Systems
       Support, Non-U.S. Gov't  Support, U.S. Gov't, P.H.S.  CLINICAL TRIAL
       CONTROLLED CLINICAL TRIAL  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).