Himelhoch Seth, Chander Geetanjali, Fleishman John A, Hellinger James, Gaist Paul, Gebo Kelly A
Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21212, USA.
Gen Hosp Psychiatry. 2007 Nov-Dec;29(6):518-25. doi: 10.1016/j.genhosppsych.2007.03.008.
Among HIV-infected individuals, we examined whether having co-occurring serious mental illness (SMI) and injection drug use (IDU) impacts: (a) receipt of highly active antiretroviral therapy (HAART), and (b) utilization of inpatient HIV services, compared to those who have SMI only, IDU only or neither SMI nor IDU.
Demographic, clinical and resource utilization data were collected from medical records of 5119 patients in HIV primary care at four US HIV care sites in different geographic regions with on-site mental health services in 2001. We analyzed receipt of HAART using multivariate logistic regression and the number of medical hospital admissions using multivariate logistic and Poisson regression analyses, which controlled for demographic factors, receipt of HAART, CD4 count and HIV-1 RNA.
Those with co-occurring SMI and IDU [adjusted odds ratio (AOR)=0.52; 95% confidence interval (95% CI)=0.41-0.81] and those with IDU alone (AOR=0.64; 95% CI=0.58-0.85) were significantly less likely to receive HAART than those with neither SMI nor IDU, controlling for demographic and clinical factors. Those with co-occurring SMI and IDU were more likely to use any inpatient medical services (AOR=2.22; 95% CI=1.64-3.01) and were significantly more likely to use them more frequently (incidence rate ratio=1.33; 95% CI=1.13-1.55) than those with neither SMI nor IDU, SMI only or IDU only.
HIV-infected individuals with co-occurring SMI and IDU are significantly more likely to utilize HIV-related medical inpatient services than individuals with no comorbidity or with only one comorbidity. Individuals with both SMI and IDU did not differ from those with IDU only in receipt of HAART. Inpatient hospitalizations are expensive, and efforts should be targeted towards these populations to reduce potentially avoidable inpatient care.
在感染艾滋病毒的个体中，我们研究了同时患有严重精神疾病（SMI）和注射吸毒（IDU）是否会影响：（a）接受高效抗逆转录病毒治疗（HAART）的情况，以及（b）与仅患有SMI、仅患有IDU或既不患有SMI也不患有IDU的个体相比，住院艾滋病毒服务的利用情况。
2001年，从美国四个不同地理区域且提供现场心理健康服务的艾滋病毒初级保健机构的5119名患者的病历中收集人口统计学、临床和资源利用数据。我们使用多变量逻辑回归分析HAART的接受情况，并使用多变量逻辑回归和泊松回归分析医疗住院次数，这些分析控制了人口统计学因素、HAART的接受情况、CD4细胞计数和HIV-1 RNA水平。
在控制人口统计学和临床因素后，同时患有SMI和IDU的个体[调整后的优势比（AOR）=0.52；95%置信区间（95%CI）=0.41 - 0.81]以及仅患有IDU的个体（AOR = 0.64；95%CI = 0.58 - 0.85）接受HAART的可能性显著低于既不患有SMI也不患有IDU的个体。与既不患有SMI也不患有IDU、仅患有SMI或仅患有IDU的个体相比，同时患有SMI和IDU的个体更有可能使用任何住院医疗服务（AOR = 2.22；95%CI = 1.64 - 3.01），并且使用频率显著更高（发病率比 = 1.33；95%CI = 1.13 - 1.55）。
与没有合并症或仅有一种合并症的个体相比，同时患有SMI和IDU的艾滋病毒感染者使用与艾滋病毒相关的住院医疗服务的可能性显著更高。同时患有SMI和IDU的个体在接受HAART方面与仅患有IDU的个体没有差异。住院治疗费用高昂，应针对这些人群采取措施，以减少潜在的可避免的住院治疗。
