With improved life
expectancy, the medical records of HIV-infected patients are
likely to be transferred repeatedly between HIV caregivers. The challenges, and
risk for introducing medical error from incomplete record transfers are poorly
understood.
We measured number of requests for record transfer, the workload
incurred, and explore, using genotypic antiretroviral resistance testing
results (GART), the potential risk of incomplete records. Using retrospective
database and chart review, we examined all patients followed
at the Southern Alberta Clinic between 1 January 2004 and 1 January 2015, and
determined how many patients transferred
care into and out our program, the associated requests and the workload for
record transfer. Using a complete record of all GART tests, the potential
importance of absent historic records in current treatment decisions was
analyzed.
The annual churn rate was 22 ± 3.4%. We received requests for only
70% of patient records who had left our care. Median time for receipt of
incoming medical records was 28 days; average clerical time for processing data
was 2 hours/record. Of all GART results, 25% exhibited resistance. Of 111 patients with
potentially misleading GART results (i.e., documented historical resistance not
visible on more recent GART), 34 (30.6%) had moved in from elsewhere. Rigorous maintenance of
the continuity of the HIV record is not universally practiced.
Resources, costs
and logistic challenges as well as a lack of appreciation of risks clearly
shown by GART testing, may be relevant barriers. Addressing such issues is
pressing as aging and transfers of care are increasingly common.
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By:
- 1 Southern Alberta HIV Clinic, Alberta Health Services , Calgary , Canada.
- 2 Department of Medicine , University of Calgary , Calgary , Alberta , Canada.
- 3 Department of Microbiology , Immunology, and Infectious Diseases, University of Calgary , Calgary , Canada.
- 4 Department of Pathology and Laboratory Medicine , University of Calgary , Calgary , Canada.
- AIDS Care. 2016 Feb 1:1-6.
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