Uphold Constance R, Mkanta William N
Rehabilitation Outcomes Research Center, University of Florida, Gainesville, Florida 32608-1197, USA.
AIDS Patient Care STDS. 2005 Aug;19(8):473-85. doi: 10.1089/apc.2005.19.473.
Health care services for persons living with HIV have broadened from short-term, crisis-oriented, and palliative care to include preventive, acute, and long-term services because of advances in HIV treatment and earlier detection. This integrated literature review on utilization of HIV-related health care services provides information on barriers to access, disparities in treatments, and factors contributing to wasteful use of services. Early research focused on describing and quantifying use of in-hospital care. As HIV transformed into a chronic disease, research on utilization expanded into outpatient settings. Predisposing factors such as race, gender, and injection drug use, and enabling factors (i.e., insurance, social support systems, housing) were strong predictors of utilization patterns. Clinical factors, such as immune status, symptoms, and depression, as well as contextual factors (i.e., characteristics of clinicians, urban/rural residence) determined the amounts of services obtained. Additional research is recommended on the utilization of nursing and preventive services and care in rehabilitation settings, home health, and nursing homes. Understanding the patterns and predictors of resource use can facilitate health professionals' efforts in improving the health care delivery system for individuals with HIV infection.
由于艾滋病病毒治疗的进展和早期检测，为艾滋病毒感染者提供的医疗保健服务已从短期、以危机为导向的姑息治疗扩大到包括预防、急性和长期服务。这篇关于艾滋病毒相关医疗保健服务利用情况的综合文献综述提供了有关获取障碍、治疗差异以及导致服务浪费的因素的信息。早期研究侧重于描述和量化住院治疗的使用情况。随着艾滋病病毒转变为一种慢性病，对利用情况的研究扩展到了门诊环境。诸如种族、性别和注射吸毒等诱发因素，以及促成因素（即保险、社会支持系统、住房）是利用模式的有力预测指标。临床因素，如免疫状态、症状和抑郁症，以及背景因素（即临床医生的特征、城市/农村居住情况）决定了获得的服务数量。建议对康复机构、家庭健康和养老院中的护理和预防服务及护理的利用情况进行更多研究。了解资源使用的模式和预测指标有助于卫生专业人员努力改善为艾滋病毒感染者提供的医疗保健系统。
