Electronic medical record systems are associated with appropriate placement of HIV patients on antiretroviral therapy in rural health facilities in Kenya: a retrospective pre-post study.
Bottom Line: There is little evidence that electronic medical record (EMR) use is associated with better compliance with clinical guidelines on initiation of antiretroviral therapy (ART) among ART-eligible HIV patients.Median time from ART eligibility to ART initiation was 29.1 days (IQR: 14.1-62.1) for paper compared to 27 days (IQR: 12.9-50.1) for EMR.However, other non-EMR factors influence timely initiation of ART.
Affiliation: Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya.Show MeSH
Mentions: The median time from ART eligibility to initiation was 29.1 days (IQR: 14.1–62.1) in the paper-based system compared to 27 days (IQR: 12.9–50.1) in the EMR system. The median time to ART initiation remained unchanged after excluding the clinics with no patients eligible for ART. However, the IQR got narrower in the paper group. Median time (excluding facility ID 12, 13, 14, 15, 16, and 17) was 29.1 days (IQR: 30.0–63.9) for paper, and 27.0 days (IQR: 12.9–50.1) for EMR. Of the patients eligible for ART, 84.5% (95% CI 82.4% to 86.4%) had initiated ART 3 months from date of eligibility using the paper-based system compared to 90.2% (95% CI 88.4% to 91.7%) using the EMR system (figure 1). EMR use was associated with a 25% increase in HR of initiation of ART among eligible patients (HR=1.25; 95% CI 1.02 to 1.52). After adjusting for patient's sex, age, WHO stage, and level of health facility, the adjusted HR of ART initiation after implementation of an EMR was 1.36 (95% CI 1.20 to 1.53).
Affiliation: Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya.