Yehia Baligh R, Gebo Kelly A, Hicks Perrin B, Korthuis P Todd, Moore Richard D, Ridore Michelande, Mathews William Christopher
Johns Hopkins University, Baltimore, Maryland 21287, USA.
AIDS Patient Care STDS. 2008 Dec;22(12):1007-13. doi: 10.1089/apc.2008.0093.
As the HIV epidemic has evolved to become a chronic, treatable condition the focus of HIV care has shifted from the inpatient to the outpatient arena. The optimal structure of HIV care in the outpatient setting is unknown. Using the HIV Research Network (HIVRN), a federally sponsored consortium of 21 sites that provide care to HIV-infected individuals, this study attempted to: (1) document key features of the organization of care in HIVRN adult clinics and (2) estimate variability among clinics in these parameters. A cross-sectional survey of adult clinic directors regarding patient volume, follow-up care, provider characteristics, acute patient care issues, wait times, patient safety procedures, and prophylaxis practices was conducted from July to December 2007. All 15 adult HIVRN clinic sites responded: 9 academic and 6 community-based. The results demonstrate variability in key practice parameters. Median (range) of selected practice characteristics were: (1) annual patient panel size, 1300 (355-5600); (2) appointment no-show rate, 28% (8%-40%); (3) annual loss to follow-up, 15% (5%-25%); (4) wait time for new appointments, 5 days (0.5-22.5), and follow-up appointment, 8 days (0-30). The majority of clinics had an internal mechanism to handle acute patient care issues and provide a number of onsite consultative services. Nurse practitioners and physician assistants were highly utilized. These data will facilitate improvements in chronic care management of persons living with HIV.
随着艾滋病病毒（HIV）疫情逐渐演变为一种可治疗的慢性病，HIV护理的重点已从住院治疗转向门诊治疗。门诊环境中HIV护理的最佳结构尚不清楚。本研究利用HIV研究网络（HIVRN），这是一个由21个为HIV感染者提供护理的机构组成的联邦资助联盟，试图：（1）记录HIVRN成人诊所护理组织的关键特征，以及（2）估计这些参数在各诊所之间的差异。2007年7月至12月，对成人诊所主任进行了一项横断面调查，内容涉及患者数量、后续护理、医护人员特征、急性患者护理问题、等待时间、患者安全程序和预防措施。HIVRN的所有15个成人诊所站点均作出了回应：9个学术型诊所和6个社区诊所。结果显示关键实践参数存在差异。选定实践特征的中位数（范围）为：（1）年度患者诊疗量，1300例（355 - 5600例）；（2）预约未到诊率，28%（8% - 40%）；（3）年度失访率，15%（5% - 25%）；（4）新预约等待时间，5天（0.5 - 22.5天），后续预约等待时间，8天（0 - 30天）。大多数诊所都有内部机制来处理急性患者护理问题并提供多项现场咨询服务。执业护士和医师助理得到了高度利用。这些数据将有助于改善HIV感染者的慢性病管理。
