Human Factors Barriers to the Effective Use of Ten HIV Clinical Reminders
- Affiliations of the authors: VA Getting at Patient Safety Center, Cincinnati VAMC, The Ohio State University, Columbus, OH (ESP); West LA VAMC, Los Angeles, CA (ADN); Center for Quality Management, VA Public Health Strategic Health Care Group, San Antonio, TX (JPH); West LA VAMC, RAND, Los Angeles, CA (SMA) USA
- Correspondence and reprints: Emily S. Patterson, PhD, 210 Baker Systems, 1971 Neil Avenue, Columbus, OH 43210; e-mail: <patterson.150{at}osu.edu>.
- Received 14 March 2003
- Accepted 22 September 2003
Abstract
Objective Substantial 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.
Design Observational 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.
Measurements Detailed handwritten field notes of interpretations and actions using the CRs and responses to interview questions were used for measurement.
Results Barriers 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).
Conclusion Six 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.
Footnotes
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This research was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (HIS 99-042, HIT-01-090). The views expressed in this article are those of the authors and do not necessarily represent the view of the Department of Veterans Affairs. A VA HSR&D Advanced Career Development Award supported Dr. Asch and a VA HSR&D Merit Review Entry Program Award supported Dr. Patterson. The authors thank Sam Bozzette, Candice Bowman, Debbie Fetters, and Henry Anaya for sharing their findings regarding the effectiveness of clinical reminder use and a quality improvement intervention on clinical outcomes. The authors thank Sophia Chang and Vandana Sundaram from the Center for Quality Management of the VA Public Health Strategic Health Care Group for collaboration on technical development, implementation, and field training of the HIV clinical reminders. The authors thank Peter Glassman for reviewing this report and providing helpful suggestions.
