ABSTRACT

1
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 Jersey
Department of Health and Senior Services,
Division of HIV/AIDS Services 2Island Peer Review
Organization
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). 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. 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. 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

• 2,304 medical records were reviewed.
• 1,797 (78) of the patients had quarterly CD4 and
  viral load tests documented on the medical
  records reviewed.
• 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.

• METHODS
• A standardized data collection tool was developed
  which included questions on CD4 count and viral
  load testing.
• The standardized data collection tool was used in
  a retrospective medical record review.
• 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.
•  
• Eligible physicians were defined as physicians
  with 10 or more patients on ADDP.
• 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.

• 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
• ADDP serves approximately 7,000 patients
  annually.
• ADDP is open formulary, therefore, providing
  access to all FDA approved antiretroviral agents
  and medications for the prophylaxis and treatment
  of opportunistic infections (OIs).
• 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
• 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.
•  
• This poster describes a retrospective medical
  record review of laboratory monitoring of
  patients on ADDP.

Sussex
Sussex
Passaic
Passaic
Bergen
Warren
Warren
Morris
Morris
Essex
Essex
Hudson
Union
Somerset
Somerset
Hunterdon
Middlesex
Middlesex
Mercer
Mercer
Monmouth
Ocean
Ocean
Burlington
Burlington
Gloucester
Gloucester
Camden
Camden
Salem
Salem
Atlantic
Atlantic
Cumberland
Cumberland
Cape
Cape
May