Human factors barriers to the effective use of ten HIV clinical reminders |
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| Institution: | 1. EVALAB, CIC-IT Lille et EA 2694, Faculté de médecine, 1 place de Verdun, 59045 Lille, France;2. LAMIH-PERCOTEC et RAIHM, UMR CNRS 8530, UVHC, Le Mont Houy, 59313 Valenciennes Cedex 9, France;1. Department of Biomedical Informatics, Vanderbilt University, Nashville, TN;2. Center for Perioperative Research in Quality, Vanderbilt University, Nashville, TN;3. Institute of Medicine and Public Health, VA Tennessee Valley Healthcare System and the Departments of Anesthesiology and Medical Education, Vanderbilt University, Nashville, TN;4. Department of Pediatrics, Vanderbilt University, Nashville, TN;1. Center for Quality Management in Public Health, Palo Alto HCS, Palo Alto, CA;2. Office of Information Field Office, Department of Veterans Affairs, Hines, IL;1. Community Guide Branch, National Center for Health Marketing, CDC, Atlanta, Georgia;2. Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia;3. National Cancer Institute, NIH, Bethesda, Maryland;4. University of North Carolina School of Public Health, Chapel Hill, North Carolina |
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| Abstract: | ObjectiveSubstantial variations in adherence to guidelines for human immunodeficiency virus (HIV) care have been documented. To evaluate their effectiveness in improving quality of care, ten computerized clinical reminders (CRs) were implemented at two pilot and eight study sites. The aim of this study was to identify human factors barriers to the use of these CRs.DesignObservational study was conducted of CRs in use at eight outpatient clinics for one day each and semistructured interviews were conducted with physicians, pharmacists, nurses, and case managers.MeasurementsDetailed handwritten field notes of interpretations and actions using the CRs and responses to interview questions were used for measurement.ResultsBarriers present at more than one site were (1) workload during patient visits (8 of 8 sites), (2) time to document when a CR was not clinically relevant (8 of 8 sites), (3) inapplicability of the CR due to context-specific reasons (9 of 26 patients), (4) limited training on how to use the CR software for rotating staff (5 of 8 sites) and permanent staff (3 of 8 sites), (5) perceived reduction of quality of provider–patient interaction (3 of 23 permanent staff), and (6) the decision to use paper forms to enable review of resident physician orders prior to order entry (2 of 8 sites).ConclusionSix human factors barriers to the use of HIV CRs were identified. Reducing these barriers has the potential to increase use of the CRs and thereby improve the quality of HIV care. |
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