Kouri Y H, Shepard D S, Borras F, Sotomayor J, Gellert G A
Harvard Institute for International Development, Harvard University, Cambridge, MA 02138.
Lancet. 1991 Jun 8;337(8754):1397-9. doi: 10.1016/0140-6736(91)93070-p.
In an era of decreasing availability of funds and increasing demand, the AIDS epidemic threatens to overwhelm health-care services in some countries. We describe a comprehensive model for the treatment of AIDS in San Juan, Puerto Rico, and compare it with traditional hospital-based services. Given the existing allocation of funds, the comprehensive model emphasised prevention, education, surveillance, early detection, and outpatient care to reduce hospital care. In 1987, the last year of the traditional system, there were 95 admissions of AIDS patients to hospital, and in 1988, the first year of the comprehensive model, there were 100 admissions. The mean length of stay of AIDS inpatients was reduced from 22.3 days in 1987 to 11.3 days in 1988, a 46.8% reduction (p = 0.001). The annual mean (SE) cost of inpatient care per AIDS patient fell from $15,118 (1699) in 1987 to $3869 (659) in 1988. Savings were used to improve non-hospital services, including outreach, education, emergency and outpatient care, laboratory and epidemiological services, and research, and to introduce an employee incentive scheme. Management strategies that reduce the length of inpatient care and provide less costly treatment alternatives can improve AIDS health care in developing nations.
在一个资金可获取性下降而需求不断增加的时代，艾滋病流行态势在一些国家有可能压垮医疗服务体系。我们描述了波多黎各圣胡安的一种艾滋病综合治疗模式，并将其与传统的以医院为基础的服务进行比较。鉴于现有资金分配情况，该综合模式强调预防、教育、监测、早期检测和门诊护理，以减少住院治疗。在传统体系的最后一年即1987年，有95名艾滋病患者入院治疗，而在综合模式的第一年即1988年，有100名患者入院。艾滋病住院患者的平均住院时间从1987年的22.3天降至1988年的11.3天，降幅为46.8%（p = 0.001）。每名艾滋病患者的年度平均（标准误）住院费用从1987年的15,118美元（1699美元）降至1988年的3869美元（659美元）。节省下来的资金用于改善非医院服务，包括外展服务、教育、急诊和门诊护理、实验室及流行病学服务以及研究，并引入了一项员工激励计划。减少住院时间并提供成本较低的治疗选择的管理策略可以改善发展中国家的艾滋病医疗服务。
