1. ABSTRACT Background: A retrospective medical record review was conducted to evaluate implementation of the Public Health Service recommendations for laboratory monitoring of HIV infected adults on the New Jersey AIDS Drug Distribution Program (ADDP). Methods: A standardized data collection tool was used to conduct a retrospective medical record review from June 1, 2001 through May 31, 2004 of patients on ADDP in 11of 21 counties. County selection was based on HIV prevalence and number of eligible physicians. Eligible physicians had 10 or more patients on ADDP. The medical records reviewed were for a calendar year. Sampling included an elimination factor for charts or physicians not found. Physician specific laboratory monitoring rates were calculated. Poor performers were defined as the bottom 5%. A continuing medical education (CME) intervention was conducted for poor performers. Results: 2,304 medical records were reviewed from 128 physicians statewide. 78% of patients had quarterly CD4and VL tests. Eleven (8.6%) physicians met the criteria for poor performers. Conclusions: Quarterly viral load and CD4 count monitoring is essential to determine if a patients needs to start antiretroviral therapy, is a virologic failure requiring a new drug regimen, or needs prophylaxis for opportunistic infections. Potential reasons for inadequate laboratory monitoring include: 1) patient non-compliance; 2) patient lost to follow-up; 3) lab results not sent to the provider; 4) incorrect collection tube used; and 5) limited clinic hours. A CME lecture series and conferences were held to provide up-to-date information on laboratory monitoring. Future plans include a post CME intervention repeat retrospective medical record review for poor performers. INTRODUCTION METHODS  A standardized data collection tool was developed which included questions on CD4 count and viral load testing.  The standardized data collection tool was used in a retrospective medical record review.  Medical records for the calendar year were reviewed from June 1, 2001 through May 31, 2004.  Based on HIV prevalence and the number of eligible physicians, 11 of the 21 counties in New Jersey were selected.  Eligible physicians were defined as physicians with 10 or more patients on ADDP.  Physician specific laboratory monitoring rates were calculated using Microsoft Access (Redmond, WA).  Poor performers were defined as physicians in the lowest 5% of those whose medical records were reviewed.  A continuing medical education (CME) intervention consisting of conferences and individual lectures was designed. Physicians were given a choice of attending these conferences/lectures or another AMA Category 1 CME lecture, conference, or enduring material that included laboratory monitoring for HIV infected persons.  Physicians received an overall summary of the data and their physician specific data. In addition, the letter sent to poor performers indicated the area in which they were a poor performer and CME options for educational remediation. RESULTS  128 physicians in 11 counties were included. The counties are shown in Figure 1.  2,304 medical records were reviewed.  1,797 (78%) of the patients had quarterly CD4 and viral load tests documented on the medical records reviewed.  11 (8.6%) of physicians met the poor performer criteria. CONCLUSIONS  Periodic viral load and CD 4 count monitoring are essential to determine if a patient needs to start antiretroviral therapy, is a virologic failure requiring a new drug regimen, or needs prophylaxis for opportunistic infections.  Potential reasons for inadequate laboratory monitoring include:  patient non-compliance;  patient lost to follow-up;  lab results not sent to the provider;  incorrect collection tube used; and  limited clinic hours.  A CME lecture series and conferences were held to provide up-to-date information on laboratory monitoring as an educational intervention for poor performers.  Future plans include a post CME intervention repeat retrospective medical record review for poor performers. REFERENCE 1.Department of Health and Human Services. Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents. October 29, 2004. A Retrospective Medical Record Review of Laboratory Monitoring of HIV Infected Adults on the New Jersey AIDS Drug Distribution Program Warren Triano-Davis, MPA 1, Sindy M. Paul, MD, MPH 1, Patti Weinberg, PA, MPS 2, Wendy Ferguson, RN, DipEd 2, Allison Xiong, PhD 2 1 New Jersey Department of Health and Senior Services, Division of HIV/AIDS Services 2 Island Peer Review Organization  The AIDS Drug Distribution Program (ADDP) is a federally funded, state administered, pharmacy benefit program for persons infected with HIV.  Eligibility criteria include infection with HIV disease, less than 500% of federal poverty level, and New Jersey Resident  ADDP serves approximately 7,000 patients annually.  ADDP is open formulary, therefore, providing access to all FDA approved antiretroviral agents and medications for the prophylaxis and treatment of opportunistic infections (OIs).  National recommendations for laboratory monitoring of HIV infected persons using CD4 counts and viral load are well established. They call for CD4 testing every 3 to 6 months and viral load testing every 3 to 4 months. 1  The CD4 count evaluates the status of the immune system. It is used to determine the need to start or ability to discontinue OI prophylaxis. It is also used in the decision to start or change antiretroviral therapy.  The viral load assesses the amount of virus present. It is used to guide treatment decisions to start or change antiretroviral therapy.  This poster describes a retrospective medical record review of laboratory monitoring of patients on ADDP. Sussex Passaic Warren Morris Essex Somerset Middlesex Mercer Ocean Burlington Camden Gloucester Salem Cumberland Atlantic Cape Sussex Passaic Bergen Warren Morris Essex Hudson Union Hunterdon Somerset Middlesex Monmouth Mercer Ocean Burlington Camden Gloucester Salem Cumberland Atlantic Cape May