The combination of interdisciplinary teamwork, antibiotic stewardship, education, and information technology is associated with replicable and sustained prescribing improvements.
This study describes the effects of a structured, educational/motivational antiretroviral adherence program on virologic and immunologic parameters in HIV-infected patients. Patients were referred because of either self- or provider-identified barriers to adherence. All patients completed 6 to 8 weekly sessions with a nurse or adherence counselor, followed by four quarterly sessions. Sessions included an adherence assessment, individualized patient education, review of adherence strategies, motivational messages, anticipatory planning, and adherence tools. The 58 patients had a mean enrollment CD4 (+) count of 223 cells/mm (3) and mean viral load of 196,454 copies/ml. At the last follow-up, the mean CD4 (+) count increased to 308 cells/mm (3) (p <.001), and mean viral load decreased to 43,309 (p <.001). Thirty (51.7%) patients achieved a viral load < 50 copies/ml at any point during follow-up. Factors associated with final viral load < 50 copies/ml included not being a cigarette smoker, receiving lamivudine in one's final regimen, and having an HIV risk behavior other than male-male sex.
It has been well established that there are racial and ethnic disparities in cardiovascular care. Quality improvement initiatives have been recommended to proactively address these disparities. An initiative was implemented to improve timeliness of and access to primary percutaneous coronary intervention (PCI) procedures among myocardial infarction patients at an academic medical center serving a predominantly minority population. The effort was part of a national quality improvement collaborative focused on improving cardiovascular care for Hispanic/Latino and African American/ black populations. The proportion of primary PCI procedures performed within 90 minutes improved significantly from 17% in the first quarter of 2006 to 93% in the fourth quarter of 2008 (P < .001). There were no significant differences in the frequency with which Hispanic/Latino or African American/black patients received primary PCI therapy in comparison to nonmembers of these groups. Quality improvement techniques can improve the quality of and access to acute cardiovascular care for minority populations.
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