Central implementation strategies outperform local ones in improving HIV testing in Veterans Healthcare Administration facilities.
J Gen Intern Med
; 28(10): 1311-7, 2013 Oct.
Article
em En
| MEDLINE
| ID: mdl-23605307
ABSTRACT
BACKGROUND:
Pilot data suggest that a multifaceted approach may increase HIV testing rates, but the scalability of this approach and the level of support needed for successful implementation remain unknown.OBJECTIVE:
To evaluate the effectiveness of a scaled-up multi-component intervention in increasing the rate of risk-based and routine HIV diagnostic testing in primary care clinics and the impact of differing levels of program support.DESIGN:
Three arm, quasi-experimental implementation research study.SETTING:
Veterans Health Administration (VHA) facilities. PATIENTS Persons receiving primary care between June 2009 and September 2011 INTERVENTION A multimodal program, including a real-time electronic clinical reminder to facilitate HIV testing, provider feedback reports and provider education, was implemented in Central and Local Arm Sites; sites in the Central Arm also received ongoing programmatic support. Control Arm sites had no intervention MAINMEASURES:
Frequency of performing HIV testing during the 6 months before and after implementation of a risk-based clinical reminder (phase I) or routine clinical reminder (phase II). KEYRESULTS:
The adjusted rate of risk-based testing increased by 0.4 %, 5.6 % and 10.1 % in the Control, Local and Central Arms, respectively (all comparisons, p < 0.01). During phase II, the adjusted rate of routine testing increased by 1.1 %, 6.3 % and 9.2 % in the Control, Local and Central Arms, respectively (all comparisons, p < 0.01). At study end, 70-80 % of patients had been offered an HIV test.CONCLUSIONS:
Use of clinical reminders, provider feedback, education and social marketing significantly increased the frequency at which HIV testing is offered and performed in VHA facilities. These findings support a multimodal approach toward achieving the goal of having every American know their HIV status as a matter of routine clinical practice.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
/
Programas de Rastreamento
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Melhoria de Qualidade
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Saúde dos Veteranos
Tipo de estudo:
Clinical_trials
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Etiology_studies
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Evaluation_studies
/
Prognostic_studies
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Risk_factors_studies
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Screening_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article