New Strategies in Clinical Guideline Delivery: Randomized Trial of Online, Interactive Decision Support Versus Guidelines for Human Immunodeficiency Virus Treatment Selection by Trainees

Author:

Ramirez Jesus A1,Maddali Manoj V2,Nematollahi Saman3,Li Jonathan Z4,Shah Maunank3

Affiliation:

1. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA

2. Department of Medicine, University of California, San Francisco, San Francisco, California, USA

3. Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA

4. Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

Abstract

Abstract Background Support for clinicians in human immunodeficiency virus (HIV) medicine is critical given national HIV-provider shortages. The US Department of Health and Human Services (DHHS) guidelines are comprehensive but complex to apply for antiretroviral therapy (ART) selection. Human immunodeficiency virus antiretroviral selection support and interactive search tool (HIV-ASSIST) (www.hivassist.com) is a free tool providing ART decision support that could augment implementation of clinical practice guidelines. Methods We conducted a randomized study of medical trainees at Johns Hopkins University, in which participants were asked to select an ART regimen for 10 HIV case scenarios through an electronic survey. Participants were randomized to receive either DHHS guidelines alone, or DHHS guidelines and HIV-ASSIST to support their decision making. ART selections were graded “appropriate” if consistent with DHHS guidelines, or concordant with regimens selected by HIV experts at 4 academic institutions. Results Among 118 trainees, participants randomized to receive HIV-ASSIST had a significantly higher percentage of appropriate ART selections compared to those receiving DHHS guidelines alone (percentage of appropriate responses in DHHS vs HIV-ASSIST arms: median [Q1, Q3], 40% [30%, 50%] vs 90% [80%, 100%]; P < .001). The effect was seen for all case types, but most pronounced for complex cases involving ART-experienced patients with ongoing viremia (DHHS vs HIV-ASSIST: median [Q1, Q3], 0% [0%, 33%] vs 100% [66%, 100%]). Conclusions Trainees using HIV-ASSIST were significantly more likely to choose appropriate ART regimens compared to those using guidelines alone. Interactive decision support tools may be important to ensure appropriate implementation of HIV guidelines. Clinical Trials Registration NCT04080765.

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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