Use of chart reminders for physicians to promote discussion of advance directives in patients with AIDS

To determine if use of a physician chart reminder improves the rate of phys ician-initiated discussion and subsequent completion of advance directives (ADs) in patients with AIDS, a controlled study was conducted with 74 patie nts with AIDS and ten physicians providing primary care at a university-bas ed hospital clinic. Chart reminders were placed on medical records of inter vention patients at each primary care clinic visit for six months. Twelve o ut of 39 (31%) reminder group patients, but only three out of 35 (9%, p = 0 .02) control patients underwent AD discussion with physicians. Further, mor e subjects in the reminder group completed ADs (28% versus 9%, p = 0.03). C ontrolling for demographic and clinical factors, only assignment to reminde r group was associated with discussion and completion of ADs. Physician-lev el analysis showed that the effect was physician-dependent. Physician chart reminders are an effective tool for promoting discussion and completion of ADs in patients with AIDS although the effect is physician-dependent.