How to improve the quality of a disease management program for HIV-infected patients using a computerized data system. The Saint-Antoine Orchestra program

Abstract

Objectives. The emergence of non-AIDS-related events in the HIV-infected population experiencing a longer life expectancy implies the implementation of a comprehensive approach of HIV clinical management through better access to care, prevention, and early diagnosis of co-morbidities. Methods. The Orchestra program is a computer-assisted HIV care and support tool implemented since December 2004 in the outpatient clinic of a University Hospital set in Paris, France. The intervention aims at improving access to HIV information care and support specifically targeted five areas of actions: cardiovascular risk factors; gynecological follow-up; anti-hepatitis B virus (HBV) vaccine coverage; sexuality and prevention of sexually transmitted infections; and compliance to antiretrovirals. The impact of this program was examined prospectively on a “before–after” basis after a two-year implementation. Results. In the two-year period, 1717 patients were regularly followed. The level of the database information significantly increased in time (low density lipoprotein (LDL) cholesterol and glycemia were informed in 74% of patients at inclusion versus 95% at two years, and 83% versus 97%, p<0.001, respectively). The number of targeted interventions was also higher. For eligible women, papanicolaou smears and mammography were prescribed in 52% of cases after intervention, versus 44% at inclusion, p=0.04 and 83% versus 50%, p<0.001, respectively. Indicators of care eventually improved significantly. Initially 72% non-adherent patients declared to be adherent after the intervention (p<0.001) and 67% of patients with initial LDL-hypercholesterolemia normalized their LDL level within two years (p<0.001). Conclusion. The Orchestra program has provided a unique opportunity to assess and improve prevention and management of co-morbidities in HIV patients.

Keywords:

• comprehensive disease management
• co-morbidities
• HIV
• software
• clinical management

Acknowledgements

Members of the Saint-Antoine Orchestra Team: F. Amrioui, A. Ayouch Boda, H. Bideault, D. Binet, F. Boccara, D. Bollens, C. Boudraa, P Campa, B. Charbonnier, A. Christiany, S. Christin-Maître, S. Clozel, A. Cohen, A. Daguenel, S. d'Almeida, G. Delamarre, F. Dere, F. Dumontet, F. Duval, L. Fonquernie, S. Fournier, PM. Girard, J. Gozlan, H. Guyon, G. Kreplak, K. Lacombe, JL. Lagneau, F. Lallemand, B. Lebeau, B. Lefebvre, C. Lefin-Ringuenet, F. Le Marec, C. Lupin-Rousselle, JL. Meynard, MC. Meyohas, L. Morand-Joubert, S. Miegi, Z. Ouazène, J. Pacanowski, JM. Poirier, JL. Poirot, C. Prat, G. Raguin, M. Rebillon, P. Roussard, B. Rousselle-Koch, P. Tangre, M. Tourneur, C. Tourette-Turgis, T. Troussier, JP. Vincensini, M. Volstein.

Patients' associations: AIDES, APA, IKAMBERE.