Int J Med Inform - Electronic decision protocols for ART patient triaging to expand access to HIV treatment in South Africa: a cross sectional study for development and validation.

Tópicos

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Resumo

CKGROUND: 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.METHODS: Patients visiting two ART clinics in South Africa for routine follow-up visits between March 2007 and 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.RESULTS: 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.CONCLUSIONS: 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.

Resumo Limpo

ckground shortag doctor nurs along futur expans rural clinic will requir major clinic visit hiv infect patient antiretrovir therapi art manag nondoctor goal studi develop evalu screen protocol determin patient need full clinic assess patient stabl enough receiv medic without doctor consult studi develop electron handheld tool guid nonphysician counselor screen questionsmethod patient visit two art clinic south africa routin followup visit march april includ studi patient screen nonphysician counselor use handheld devic receiv full clinic assess clinician report whether full clinic assess necessari use gold standard determin requir referr observ random divid two dataset develop referr protocol valid protocol performanceresult third patient least one physic complaint five physic complaint patient requir referr full clinic assess identifi subset question sensit specif recommend patient referralconclus final screen protocol high sensit reduc burden art clinician uptak accept handheld tool support implement protocol high examin data reveal sever import question includ futur referr algorithm improv sensit specif base result identifi refin algorithm explor futur evalu

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