Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States of America.
VA Connecticut Healthcare System, West Haven, CT, United States of America; Yale University, New Haven, CT, United States of America.
Contemp Clin Trials. 2023 Sep;132:107303. doi: 10.1016/j.cct.2023.107303. Epub 2023 Jul 20.
Chronic obstructive pulmonary disease (COPD) is one of the most common comorbid diseases among aging people with HIV (PWH) and is often mismanaged. To address this gap, we are conducting the study, "Advancing care for COPD in people living with HIV by Implementing Evidence-based management through proactive E-consults (ACHIEVE)." This intervention optimizes COPD management by promoting effective, evidence-based care and de-implementing inappropriate therapies for COPD in PWH receiving care at Veteran Affairs (VA) medical centers. Study pulmonologists are proactively supporting ID providers managing a population of PWH who have COPD, offering real-time evidence-based recommendations tailored to each patient. We are leveraging VA clinical and informatics infrastructures to communicate recommendations between the study team and clinical providers through the electronic health record (EHR) as an E-consult. If effective, ACHIEVE could serve as a model of effective, efficient COPD management among PWH receiving care in VA. This paper outlines the rationale and methodology of the ACHIEVE trial, one of a series of studies funded by the National Heart, Lung, and Blood Institute (NHLBI) within the ImPlementation REsearCh to DEvelop Interventions for People Living with HIV (PRECluDE) consortium to study chronic disease comorbidities in HIV populations.
慢性阻塞性肺疾病（COPD）是老年 HIV 感染者（PWH）中最常见的合并症之一，且常常管理不善。为了解决这一差距，我们正在开展一项研究，即“通过主动电子咨询实施基于证据的管理来改善 HIV 感染者 COPD 管理（ACHIEVE）”。该干预措施通过促进有效的、基于证据的护理并为在退伍军人事务部（VA）医疗中心接受治疗的 PWH 停止不适当的 COPD 治疗来优化 COPD 管理。研究肺科医生积极支持管理 COPD 患者的 ID 提供者，为每位患者提供量身定制的实时基于证据的建议。我们正在利用 VA 临床和信息学基础设施，通过电子病历（EHR）作为电子咨询在研究团队和临床提供者之间传递建议。如果有效，ACHIEVE 可以作为 VA 中接受治疗的 PWH 中有效、高效 COPD 管理的模型。本文概述了 ACHIEVE 试验的基本原理和方法，ACHIEVE 是由美国国立心肺血液研究所（NHLBI）在 HIV 人群慢性疾病合并症研究（PRECluDE）联盟下资助的一系列研究之一。
