As our collective understanding of HIV pathology grows, yielding more sophisticated and successful treatments, so must the knowledge of front-line clinicians. To help, a new Agency for Healthcare Research and Quality (AHRQ) award will fund a URMC research team aiming to better circulate evidence-based practice guidelines amongst community providers who care for HIV-positive patients.
Keeping these doctors, nurses, and others abreast of the latest advances in care and treatment is no small feat; it requires creative communication tactics that connect with clinicians where they are, in real-time, leveraging web, social media, online communities, mobile apps and more. With the new $900,000, three-year R24 grant, Dongwen Wang, Ph.D., and Amneris Luque, M.D., will lead a team in pioneering fresh ways to deliver up-to-the-minute information.
“With today’s medications and good specialist care, AIDS is no longer the fatal disease it was 20 years ago,” said Luque, an associate professor of Medicine and Director of AIDS Clinic at URMC. “Instead, we face a completely new challenge: Caring for unique health needs of the first generation of aging AIDS patients. Treatments are improving at a brisk pace. This makes ongoing education and communication essential.”
Associate professor of Biostatistics and Computational Biology, Wang is a formally trained health informatician. As principal investigator for the award, he brings a wealth of expertise translating new biomedical insights into mainstream clinical care – often in ways that improve efficiency at the same time.
“In its simplest sense, health informatics is about using technology to connect health care providers and patients with the latest information, so care is as safe, effective, and as current as possible,” he said. “With this funding, we’ll be able to look closely at how today’s clinicians interface with technology, how it merges with their daily lives and their clinical workflows. We want to harness those natural opportunities to disseminate new clinical guidelines.”
The need is great; HIV science is moving at a fast clip. Years ago, the best medicines were, at the same time, difficult to tolerate because they carried serious side effects. Patients only were prescribed the drugs at the point when benefits clearly outweighed the inherent risk. That’s since changed dramatically; more elegant, gentler drugs are now available, which means patients can better stick to their treatment – a key factor for successful disease management.
New HIV guidelines also arrive on scene every a few months. Take the issue of post-exposure prophylaxis; if a health care worker is accidentally stuck with a needle, treatment needs to start immediately, ideally within mere hours of the exposure. But the medications prescribed months ago are likely no longer the best available, according to the latest guideline released by the New York State Department of Health AIDS Institute. Having the latest information ensures that health care providers and patients alike can take advantage of the best medicines science offers.
“Clinicians can’t wait around for advice in the next journal,” Luque said. “They need information at their fingertips, as soon as it’s available. This grant challenges us find novel ways to make that happen.”
Over the past seven years, Wang and Luque have accumulated significant experience and resources through their work running part of the six-center New York State Department of Health-sponsored HIV Clinical Education Initiative (CEI).
Tasked by the CEI program to serve dual roles – as initiative’s Technology Center, and its Resource & Referral Center – the URMC team has developed a highly effective information clearinghouse that helps busy health care providers stay abreast of the evolving understanding of HIV/AIDS care and treatment, right from their computers. New courses being added all the time, with clinically relevant topics range from understanding vitamin D deficiencies in HIV-infected patients, to taking a closer look at the trend towards young men increasingly having unprotected sex with other men (and exploring infection prevention strategies that work best for this group). Online courses typically last an hour and consist of a PowerPoint slideshow narrated by an expert educator. A brief quiz follows each presentation; once finished, participants can print a certificate of completion.
Since its launch in 2009, the CEI’s free online education program has reached out to 31,000 individuals from all 50 U.S. States and 160 countries around the world, enriching their HIV clinical knowledge through online CME/CNE courses, multimedia learning modules, interactive case simulation tools, mobile training resources, and more. Participating clinicians have earned a collective 2,100 CME/CNE credits. The CEI website (www.ceitraining.org) has recorded an impressive 64,000 visitors and 278,000 page views; Google and other search engines now consistently rank it a top site for HIV clinical education.
Still, fresh approaches are needed. The newly funded AHRQ grant will significantly enhance the existing CEI programming – spawning new partnerships, introducing multi-disciplinary communication and dissemination research, augmenting the online repository of HIV/AIDS information products, and evaluating the usability and impact of existing resources.
Other members of the URMC HIV clinical education research team are Monica Barbosu, Matt Bernhardt, Tom DellaPorta, Terry Doll, and Hung Le.