Evidence-based decision support in HIV/TB care:, de,

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Evidence-based decision support in HIV/TB care:, de, Wannheden, Carolina, emne: krop og sundhed

Evidence-based decision support in HIV/TB care: de, Wannheden, Carolina, emne: krop og sundhed

dc.contributor.author Wannheden, Carolina
dc.date.accessioned 2014-09-05T08:12:48Z
dc.date.available 2014-09-05T08:12:48Z
dc.date.issued 2014-09-05
dc.identifier.isbn 978-91-7549-643-6 en_US
dc.identifier.uri http://hdl.handle.net/10616/42142
Introduction: HIV and tuberculosis (TB) coinfection, which is a major challenge for healthcare systems worldwide, requires effective strategies to support care providers in applying best clinical evidence in making treatment decisions about the care of individ- ual patients. Clinical decision support (CDS) systems have the potential to facilitate the implementation of evidence-based guidelines in clinical practice. Aim: The aim of this thesis was to explore how a CDS system could be designed to sup- port the adoption of evidence-based guidelines in the treatment of HIV-related TB. Study design: The HIV outpatient clinic at the Karolinska University Hospital, Huddinge, Stockholm, was the setting for a user-centered design approach structured in three phases: contextual analysis (Studies I and II), design (Study III), and evaluation (Study IV). Study I explores care providers’ challenges and requirements; Study II, which describes socio- demographic and clinical characteristics of patients in this setting, analyzes the factors associated with anti-TB treatment success as well as adverse drug reactions; Study III proposes a CDS framework of drug therapy recommendations that is applied to HIV- related TB treatment guidelines; Study IV formatively evaluates the conceptual design of a CDS prototype that is based on the framework developed in Study III. Methods: In Study I, the contextual analysis is based on observations and interviews. Study II analyses patient treatment outcomes in the research setting between the years 1987 to 2010 (inclusive). Study III presents the design that is based on prototyping and guideline modeling. Study IV u