A Low-Effort, Clinic-Wide Intervention Improves Attendance for HIV Primary Care: Publication and Corresponding Tools

The Low Cost-Low Effort Clinic-wide intervention, funded by HRSA and CDC, was conducted between 2009 and 2010 in six academically-affiliated HIV clinics in the U.S. See the publication (Gardner, et al. Clin Inf Dis (2012) 55: 1124-1134.) for details. The rationale for the study was that a clinic-wide intervention based on a combination of audio-visual materials and very brief verbal messages to patients might change patients’ attendance rates at scheduled appointments for HIV primary care. During the intervention, the waiting room posters were placed at prominent locations in the clinic waiting rooms, and the exam room posters were placed in all the exam rooms. Patients received at least one of the patient brochures during the intervention year (either from the front desk staff or a nurse). Clinicians and clinic staff were trained by faculty from the former Mountain Plains AETC on how to deliver the messages printed on the Pocket Guides.

The training video was used during that training. Clinicians delivered their messages in the exam room and used the exam room poster for additional reinforcement. The study used the registration data supplied by each clinic to track scheduled visits and arrived visits for 12-months. The study investigators compared the intervention (2009-2010) vs. pre-intervention (2008-2009) years for (a) rates of keeping the next two visits after initiation of the intervention, and (b) percentage of visits kept in a 12-month interval. The investigators found improvement in clinic attendance ranged from 7% for 2 consecutive appointments to 3% for the proportion of all appointments kept. There was a larger impact on new or re-engaging patients, younger patients, and patients with a detectable viral load. The materials were produced at U.S. government expense (there is no copyright) and were cleared by the CDC and HHS content review process for material that will be shown to the general public. The posters, brochure (flyer), pocket guides and training video may be reproduced locally by clinics that wish to use these materials. The tri-fold brochure was converted into an 8 x 11 flyer—a format that might be easier to reproduce locally.

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