What Works for Children? International Workshop on HIV Pediatrics

When you're working in an HIV clinic that routinely sees 80 to 100 children in a single day, you don't have as much time for thinking as you might like. The benches outside of your clinic room are packed with mothers and grandmothers and aunties and children of all ages. You have a huge stack of patient charts on your desk, each one representing a child who needs to be seen. And as much as you care about your patients (and as smart as you  think you are), your brain struggles to keep up.

Clinic _babies Mamas Waiting

In the face of this workload and each patient's complex set of clinical problems, it is all too easy to miss things. A child needs to have monitoring labs drawn every six months and needs regular tests and chest x-rays and various prescriptions, but the children are really sick and the families have complicated issues like not having enough food or getting kicked out of their home because they have HIV. And sometimes we doctors push things off until next month's visit or just forget one of the many details that need to be done. Does your baby need a certain test done today? Some times, it gets lost in the blur of problems and prescriptions and other orders.

It is into this gap that we have been working on computerized reminders to help clinicians by reminding them when a child is overdue to have something done. "It's time to order this lab," says our reminder. Or, "this child is malnourished and needs to be referred for nutrition support." We take information about the patient from their electronic medical record and use it to give the clinicians tailored reminders about what a given patient needs.

We think that things like this will work, but it's important to actually have some proof! So, we've been running a study in the pediatric HIV clinic in Kenya to see if our reminders work. Happily, they do. We see a four-fold increase in how likely the clinicians are to fix overdue problems in caring for children when we remind them about it.

It's always great when things work! Our study shows that these reminders work nicely, and so I had the chance to present those results with a big group of several hundred pediatricians doing international HIV work among children. My body is tired from Kenya-Italy-Indiana-Washington DC travel, but it's lovely to be among "my people" for the International Workshop on HIV Pediatrics. I'm talking about our research work in Kenya, getting new ideas, hearing about the amazing work other researchers are doing (vaccines and cures for AIDS - how we need them!), and learning lots about caring for children with HIV.

Posted at 18:45


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