Study Describes Effective Clinical Decision Support Tool for HIV Symptom Management

Common symptoms associated with HIV disease and/or its management are often under-recognized and, thus, under-treated. Moreover, although antiretroviral therapy has greatly increased life expectancy, the associated side-effects can decrease quality of life as well as medication adherence. This pilot study produced a clinical decision support tool called TEMS that was developed to: elicit information about symptoms at routine clinic visits; organize information to emphasize what is most useful for clinical care; present information at the point-of-care; and recommend clinical responses based on that information. As part of VA's electronic medical record, TEMS was implemented to increase provider awareness of and response to common HIV symptoms (i.e., fatigue, pain, anxiety, weight loss). Investigators then studied the tool's feasibility in routine care within a weekly HIV clinic, comparing a 4-week intervention period (mid-April through mid-May 2007) with a 4-week control period (March 2007) for 56 Veterans and their providers.

Findings show that TEMS was accepted by Veterans and their providers and did not substantially impede workflow. In addition, there was a trend toward including a greater number of symptoms in the progress notes documented during the intervention period compared to the control period. This study was not designed to detect the tool's effectiveness; however, 93% of the Veterans in the intervention group reported that their providers were very aware of their symptoms vs. 75% of the Veterans in the control group. The authors suggest that there are many possible ways to use clinical decision support systems to individualize patient care, as electronic medical record data may be combined with self-reported patient information in a wide range of domains (i.e., symptoms, behaviors, clinical data). The resulting information could then be used to tailor clinical strategies for individual patients.

Nader C, Tsevat J, Justice A, et al. Development of an electronic medical record-based clinical decision support tool to improve HIV symptom management. AIDS Patient Care and STDs July 2009;23(7):521-529.

This study was funded by HSR&D. Drs. Tsevat and Justice are part of VA/HSR&D's HIV/Hepatitis Quality Enhancement Research Initiative.