病例管理对艾滋病毒感染者未满足需求以及医疗护理和药物使用情况的影响。

Effect of case management on unmet needs and utilization of medical care and medications among HIV-infected persons.

作者信息

Katz M H, Cunningham W E, Fleishman J A, Andersen R M, Kellogg T, Bozzette S A, Shapiro M F

机构信息

Department of Public Health, 101 Grove Street, Room 308, San Francisco, CA 94102-4505, USA.

出版信息

Ann Intern Med. 2001 Oct 16;135(8 Pt 1):557-65. doi: 10.7326/0003-4819-135-8_part_1-200110160-00006.

DOI:10.7326/0003-4819-135-8_part_1-200110160-00006

PMID:11601927

Abstract

BACKGROUND

Although case management has been advocated as a method for improving the care of chronically ill persons, its effectiveness is poorly understood.

OBJECTIVE

To assess the effect of case managers on unmet need for supportive services and utilization of medical care and medications among HIV-infected persons.

DESIGN

Baseline and follow-up interview of a national probability sample.

SETTING

Inpatient and outpatient medical facilities in the United States.

PARTICIPANTS

2437 HIV-infected adults representing 217 081 patients receiving medical care.

MEASUREMENTS

Outcomes measured at follow-up were unmet need for supportive services, medical care utilization (ambulatory visits, emergency department visits, and hospitalizations), and use of HIV medication (receipt of antiretroviral therapy and prophylaxis against Pneumocystis carinii pneumonia and toxoplasmosis).

RESULTS

At baseline, 56.5% of the sample had contact with a case manager in the previous 6 months. In multiple logistic regression analyses that adjusted for potential confounders, contact with a case manager at baseline was associated with decreased unmet need for income assistance (odds ratio [OR], 0.57 [95% CI, 0.36 to 0.91]), health insurance (OR, 0.54 [CI, 0.33 to 0.89]), home health care (OR, 0.29 [CI, 0.15 to 0.56]), and emotional counseling (OR, 0.62 [CI, 0.41 to 0.94]) at follow-up. Contact with case managers was not significantly associated with utilization of ambulatory care (OR, 0.77 [CI, 0.57 to 1.04]), hospitalization (OR, 1.13 [CI, 0.84 to 1.54]), or emergency department visits (OR, 1.30 [CI, 0.97 to 1.73]) but was associated with higher utilization of two-drug (OR, 1.58 [CI, 1.23 to 2.03]) and three-drug (OR, 1.34 [CI, 1.00 to 1.80]) antiretroviral regimens and of treatment with protease inhibitors or non-nucleoside reverse transcriptase inhibitors (OR, 1.29 [CI, 1.02 to 1.64]) at follow-up.

CONCLUSIONS

Case management appears to be associated with fewer unmet needs and higher use of HIV medications in patients receiving HIV treatment.

摘要

背景

尽管病例管理已被倡导为改善慢性病患者护理的一种方法，但其有效性仍知之甚少。

目的

评估病例管理人员对艾滋病毒感染者未满足的支持性服务需求以及医疗护理和药物使用情况的影响。

设计

对全国概率样本进行基线和随访访谈。

地点

美国的住院和门诊医疗设施。

参与者

2437名感染艾滋病毒的成年人，代表217081名接受医疗护理的患者。

测量指标

随访时测量的结果包括未满足的支持性服务需求、医疗护理利用情况（门诊就诊、急诊就诊和住院）以及艾滋病毒药物使用情况（接受抗逆转录病毒治疗以及预防卡氏肺孢子虫肺炎和弓形虫病）。

结果

在基线时，56.5%的样本在过去6个月内与病例管理人员有过接触。在对潜在混杂因素进行调整的多项逻辑回归分析中，基线时与病例管理人员接触与随访时未满足的收入援助需求降低（比值比[OR]，0.57[95%置信区间，0.36至0.91]）、医疗保险需求降低（OR，0.54[置信区间，0.33至0.89]）、家庭医疗护理需求降低（OR，0.29[置信区间，0.15至0.56]）以及情感咨询需求降低（OR，0.62[置信区间，0.41至0.94]）相关。与病例管理人员接触与门诊护理利用情况（OR，0.77[置信区间，0.57至1.04]）、住院情况（OR，1.13[置信区间，0.84至1.54]）或急诊就诊情况（OR，1.30[置信区间，0.97至1.73]）无显著关联，但与随访时更高的双药（OR，1.58[置信区间，1.23至2.03]）和三药（OR，1.34[置信区间，1.00至1.80]）抗逆转录病毒治疗方案使用情况以及蛋白酶抑制剂或非核苷类逆转录酶抑制剂治疗使用情况（OR，1.29[置信区间，1.02至1.64]）相关。