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. 2014 Nov-Dec;21(6):1009-14.
doi: 10.1136/amiajnl-2013-002447. Epub 2014 Jun 9.

Electronic medical record systems are associated with appropriate placement of HIV patients on antiretroviral therapy in rural health facilities in Kenya: a retrospective pre-post study

Tom Oluoch  1 , Abraham Katana  1 , Victor Ssempijja  1 , Daniel Kwaro  2 , Patrick Langat  2 , Davies Kimanga  3 , Nicky Okeyo  2 , Ameen Abu-Hanna  4 , Nicolette de Keizer  4
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Electronic medical record systems are associated with appropriate placement of HIV patients on antiretroviral therapy in rural health facilities in Kenya: a retrospective pre-post study

Tom Oluoch et al. J Am Med Inform Assoc. 2014 Nov-Dec.

Abstract

Background and objective: There is little evidence that electronic medical record (EMR) use is associated with better compliance with clinical guidelines on initiation of antiretroviral therapy (ART) among ART-eligible HIV patients. We assessed the effect of transitioning from paper-based to an EMR-based system on appropriate placement on ART among eligible patients.

Methods: We conducted a retrospective, pre-post EMR study among patients enrolled in HIV care and eligible for ART at 17 rural Kenyan clinics and compared the: (1) proportion of patients eligible for ART based on CD4 count or WHO staging who initiate therapy; (2) time from eligibility for ART to ART initiation; (3) time from ART initiation to first CD4 test.

Results: 7298 patients were eligible for ART; 54.8% (n=3998) were enrolled in HIV care using a paper-based system while 45.2% (n=3300) were enrolled after the implementation of the EMR. EMR was independently associated with a 22% increase in the odds of initiating ART among eligible patients (adjusted OR (aOR) 1.22, 95% CI 1.12 to 1.33). The proportion of ART-eligible patients not receiving ART was 20.3% and 15.1% for paper and EMR, respectively (χ(2)=33.5, p<0.01). Median time from ART eligibility to ART initiation was 29.1 days (IQR: 14.1-62.1) for paper compared to 27 days (IQR: 12.9-50.1) for EMR.

Conclusions: EMRs can improve quality of HIV care through appropriate placement of ART-eligible patients on treatment in resource limited settings. However, other non-EMR factors influence timely initiation of ART.

Keywords: Developing countries; Guidelines adherence; HIV; Medical Records; Quality of healthcare.

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Figures

Figure 1
Figure 1
Time from eligibility to ART initiation.
Figure 2
Figure 2
Time from ART initiation to first CD4+ T-cell test.
See this image and copyright information in PMC

References

    1. Amoroso CL, Akimana B, Wise B, et al. Using electronic medical records for HIV care in rural Rwanda. Stud Health Technol Inform 2010;160(Pt 1):337–41 - PubMed
    1. Castelnuovo B, Kiragga A, Afayo V, et al. Implementation of provider-based electronic medical records and improvement of the quality of data in a large HIV program in Sub-Saharan Africa. PLoS ONE 2012;7:e51631. - PMC - PubMed
    1. Cebul RD, Love TE, Jain AK, et al. Electronic health records and quality of diabetes care. N Engl J Med 2011;365:825–33 - PubMed
    1. Landis LZ, Mello-Thoms C, Gadabu OJ, et al. The feasibility of automating audit and feedback for ART guideline adherence in Malawi. J Am Med Inform Assoc 2011;18:868–74 - PMC - PubMed
    1. Were MC, Shen C, Tierney WM, et al. Evaluation of computer-generated reminders to improve CD4 laboratory monitoring in sub-Saharan Africa: a prospective comparative study. J Am Med Inform Assoc 2011;18:150–5 - PMC - PubMed

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