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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1109 — How Primary Care Providers Prioritize HIV Testing and General Preventive Care

Solomon JL, Center for Health Quality, Outcomes & Economic Research, ENRM VA Hospital, Bedford; Gifford AL, VA New England Healthcare System; Asch S, VA Palo Alto Healthcare System; Thomas CM, VA San Diego Healthcare System; Stevens J, VA New Jersey Healthcare System; Mueller N, and Bokhour BG, Center for Health Quality, Outcomes & Economic Research, ENRM VA Hospital, Bedford;

Objectives:
Providers do not regularly address the full range of recommended preventive care during clinical encounters. The purpose of this study was to examine how VA primary care providers prioritize preventive care tasks during patient visits in clinics with both general preventive care clinical reminders (CRs) and HIV testing CRs. We compared prioritizing general preventive care tasks with offering HIV testing to at-risk patients.

Methods:
We conducted a qualitative interview study with primary care providers at two urban VA medical centers. Interviews were in-depth and semi-structured, and were conducted by phone. All interviews were audio-recorded and transcribed verbatim. Investigators read the same 10 interview transcripts and met regularly to discuss, debate, and come to consensus about codes and emerging themes. Remaining transcripts were coded by rotating pairs of investigators, to refine themes and emerging sub-themes. Analysts then shared findings with the entire study team, discussed them, and came to consensus about them.

Results:
Thirty-one providers were interviewed: 22 physicians and nine nurse practitioners. Most providers spontaneously mentioned using prioritization strategies for general preventive care in explicit contrast to using CRs. Providers noted their dislike of CRs and described two alternative strategies for prioritizing care: 1) Using independent clinical judgment to determine which preventive care tasks are appropriate in the context of patients’ health and well-being, and 2) utilizing electronic medical record notes and problem lists to track preventive care topics. In the case of HIV testing, however, most providers said they rely on CRs to prompt them to offer it, noting that the CR’s one-time occurrence and straightforward design rendered it easy to use compared with general preventive care CRs.

Implications:
Providers relied more on clinical judgment, rather than CRs, to prioritize general preventive care. However, most providers relied on the HIV testing CR to prioritize testing. This might be due to the relative ease of using the CR and its one-time occurrence.

Impacts:
As VA’s National Center for Health Promotion and Disease Prevention considers how and when to implement CRs, it is important to recognize providers’ practice preferences and their focus on aligning care with individual patient needs.


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