Transcript Posters\PH Week March 05\ADDP.rutgers

A Retrospective Medical Record Review of Laboratory Monitoring of HIV Infected Adults
on the New Jersey AIDS Drug Distribution Program
Warren Triano-Davis, MPA1, Sindy M. Paul, MD, MPH1, Patti Weinberg, PA, MPS2, Wendy Ferguson, RN, DipEd2, Allison Xiong, PhD2
1New
ABSTRACT
Background: A retrospective medical record review was conducted to evaluate
implementation of the Public Health Service recommendations for laboratory monitoring of
HIV infected adults on the New Jersey AIDS Drug Distribution Program (ADDP).
Jersey Department of Health and Senior Services, Division of HIV/AIDS Services
2Island Peer Review Organization
 2,304 medical records were reviewed.
METHODS
 A standardized data collection tool was developed which included questions on CD4
count and viral load testing.
Methods: A standardized data collection tool was used to conduct a retrospective medical
record review from June 1, 2001 through May 31, 2004 of patients on ADDP in 11of 21
counties. County selection was based on HIV prevalence and number of eligible
physicians. Eligible physicians had 10 or more patients on ADDP. The medical records
reviewed were for a calendar year. Sampling included an elimination factor for charts or
physicians not found. Physician specific laboratory monitoring rates were calculated. Poor
performers were defined as the bottom 5%. A continuing medical education (CME)
intervention was conducted for poor performers.
 The standardized data collection tool was used in a retrospective medical record review.
Results: 2,304 medical records were reviewed from 128 physicians statewide. 78% of
patients had quarterly CD4and VL tests. Eleven (8.6%) physicians met the criteria for poor
performers.
 Eligible physicians were defined as physicians with 10 or more patients on ADDP.
Conclusions: Quarterly viral load and CD4 count monitoring is essential to determine if a
patients needs to start antiretroviral therapy, is a virologic failure requiring a new drug
regimen, or needs prophylaxis for opportunistic infections. Potential reasons for
inadequate laboratory monitoring include: 1) patient non-compliance; 2) patient lost to
follow-up; 3) lab results not sent to the provider; 4) incorrect collection tube used; and 5)
limited clinic hours. A CME lecture series and conferences were held to provide up-to-date
information on laboratory monitoring. Future plans include a post CME intervention repeat
retrospective medical record review for poor performers.
INTRODUCTION
 Medical records for the calendar year were reviewed from June 1, 2001 through May 31,
2004.
 Based on HIV prevalence and the number of eligible physicians, 11 of the 21 counties in
New Jersey were selected.
 Physician specific laboratory monitoring rates were calculated using Microsoft Access
(Redmond, WA).
 Poor performers were defined as physicians in the lowest 5% of those whose medical
records were reviewed.
 A continuing medical education (CME) intervention consisting of conferences and
individual lectures was designed. Physicians were given a choice of attending these
conferences/lectures or another AMA Category 1 CME lecture, conference, or enduring
material that included laboratory monitoring for HIV infected persons.
 Physicians received an overall summary of the data and their physician specific data. In
addition, the letter sent to poor performers indicated the area in which they were a poor
performer and CME options for educational remediation.
 The AIDS Drug Distribution Program (ADDP) is a federally funded, state administered,
pharmacy benefit program for persons infected with HIV.
 Eligibility criteria include infection with HIV disease, less than 500% of federal poverty
level, and New Jersey Resident
 128 physicians in 11 counties were included. The counties are shown in Figure 1.
 ADDP serves approximately 7,000 patients annually.
Sussex
Sussex Passaic
Passaic
Bergen
Warren
Warren
 National recommendations for laboratory monitoring of HIV infected persons using
CD4 counts and viral load are well established. They call for CD4 testing every 3 to 6
months and viral load testing every 3 to 4 months.1
Hunterdon
Morris
Morris
Somerset
Ocean
Ocean
Burlington
Burlington
Gloucester
Camden
Gloucester
Camden
Salem
Salem
Atlantic
Atlantic
Cumberland
Cumberland
Cape
 This poster describes a retrospective medical record review of laboratory monitoring of
patients on ADDP.
Union
Somerset
Middlesex
Mercer
Monmouth
Mercer
 The CD4 count evaluates the status of the immune system. It is used to determine the
need to start or ability to discontinue OI prophylaxis. It is also used in the decision to
start or change antiretroviral therapy.
 The viral load assesses the amount of virus present. It is used to guide treatment
decisions to start or change antiretroviral therapy.
Essex
EssexHudson
Middlesex
Cape
May
 11 (8.6%) of physicians met the poor performer criteria.
CONCLUSIONS
 Periodic viral load and CD 4 count monitoring are essential to determine if a patient
needs to start antiretroviral therapy, is a virologic failure requiring a new drug regimen,
or needs prophylaxis for opportunistic infections.
 Potential reasons for inadequate laboratory monitoring include:
 patient non-compliance;
 patient lost to follow-up;
 lab results not sent to the provider;
 incorrect collection tube used; and
 limited clinic hours.
 A CME lecture series and conferences were held to provide up-to-date information on
laboratory monitoring as an educational intervention for poor performers.
 Future plans include a post CME intervention repeat retrospective medical record
review for poor performers.
REFERENCE
1. Department of Health and Human Services. Guidelines for the Use of Antiretroviral
Agents in HIV-1 Infected Adults and Adolescents. October 29, 2004.
RESULTS
 ADDP is open formulary, therefore, providing access to all FDA approved antiretroviral
agents and medications for the prophylaxis and treatment of opportunistic infections
(OIs).
 1,797 (78%) of the patients had quarterly CD4 and viral load tests documented on the
medical records reviewed.