Patient activation and improved outcomes in HIV-infected patients.

BACKGROUND: The Patient Activation Measure (PAM) assesses several important concepts in chronic care management, including self-efficacy for positive health behaviors. In HIV-infected populations, better self-efficacy for medication management is associated with improved adherence to antiretroviral medications (ARVs), which is critically important for controlling symptoms and slowing disease progression. OBJECTIVE: To determine 1) characteristics associated with patient activation and 2) associations between patient activation and outcomes in HIV-infected patients. DESIGN: Cross-sectional survey. PARTICIPANTS: 433 patients receiving care in four HIV clinics. METHODS: An interviewer conducted face-to-face interviews with patients following their HIV clinic visit. Survey data were supplemented with medical record abstraction to obtain most recent CD4 counts, HIV viral load and antiretroviral medications. MAIN MEASURES: Patient activation was measured using the 13-item PAM (possible range 0-100). Outcomes included CD4 cell count > 200 cells/mL(3), HIV-1 RNA < 400 copies/mL (viral suppression), and patient-reported adherence. KEY RESULTS: Overall, patient activation was high (mean PAM = 72.3 [SD 16.5, range 34.7-100]). Activation was lower among those without vs. with a high school degree (68.0 vs. 74.0, p < .001), and greater depression (77.6 lowest, 70.2 middle, 68.1 highest tertile, p < .001). There was no association between patient activation and age, race, gender, problematic alcohol use, illicit drug use, or social status. In multivariable models, every 5-point increase in PAM was associated with greater odds of CD4 count > 200 cells/mL(3) (aOR 1.10 [95 % CI 1.01, 1.21]), adherence (aOR 1.18 [95 % CI 1.09, 1.29]) and viral suppression (aOR 1.08 [95 % CI 1.00, 1.17]). The association between PAM and viral suppression was mediated through adherence. CONCLUSIONS: Higher patient activation was associated with more favorable HIV outcomes. Interventions to improve patient activation should be developed and tested for their ability to improve HIV outcomes.

Electronic reporting of pelvic inflammatory disease from an emergency department.

BACKGROUND AND OBJECTIVES: Pelvic inflammatory disease (PID) is a clinically diagnosed condition that is preventable and underreported. We developed an electronic emergency department (ED) PID reporting system by using an automatic and secure system to send computerized clinician PID diagnoses to the state health department. GOAL: The goal of this study was to assess if electronic transmission of ED PID data could enhance the completeness and timeliness of PID surveillance. STUDY DESIGN: We conducted a retrospective chart review. METHODS: To validate electronic ED diagnoses, we reviewed charts of 157 women with 7 clinicians' diagnoses compatible with PID. We determined which women met the Centers for Disease Control and Prevention (CDC) PID surveillance case definition and determined the positive predictive values of electronic ED diagnoses of PID. We compared completeness of electronic PID reporting with state sexually transmitted disease surveillance. RESULTS: Three diagnoses were appropriate for electronic PID surveillance. Information on women with these diagnoses is sent daily to the health department with no extra effort needed from ED clinicians. Less than 10% of women who met the CDC PID case definition were reported within 6 months through conventional methods. CONCLUSIONS: Electronic ED surveillance will improve completeness and timeliness of PID reporting.

HIV infection risk, behaviors, and attitudes about testing: are perceptions changing?

BACKGROUND: People at high risk for HIV infection could be increasing their risk behaviors, especially now that improved treatments for HIV infection are available. GOAL: The goal was to investigate whether risk behaviors, perceptions of personal risk for HIV infection, and attitudes toward HIV testing among high-risk persons in Oregon differed in 1996 and 1998. STUDY DESIGN: Data from the HIV Testing Survey (HITS), a cross-sectional survey administered to HIV-negative men who have sex with men (MSM), heterosexual adults at high-risk for sexually transmitted diseases (STD), and intravenous drug users (IDUs) at high risk for HIV infection in 1996 (HITS-I), were compared with data from a similar group surveyed in 1998 (HITS-II). RESULTS: Proportions of participants reporting specific risk behaviors remained relatively constant in 1996 and 1998. Personal risk of HIV infection was perceived as low by 54% of HITS-II participants and 61.2% of HITS-I participants (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.9-1.7). IDUs in HITS-II were more likely than IDUs in HITS-I to perceive their risk as low (OR, 2.1; 95% CI, 1.2-3.7). CONCLUSION: Persons at high risk might underestimate their risk for HIV infection while practicing risky behaviors. The prevalence of risk behaviors in these populations could be considered the baseline against which to measure future prevention efforts.