Southern Alberta Clinic, Sheldon M Chumir Health Centre, Calgary, AB, Canada.
J Acquir Immune Defic Syndr. 2011 May 1;57(1):51-4. doi: 10.1097/QAI.0b013e318214feee.
Studies on patient mobility have focused on patients who become lost-to-follow-up (LTFU). Much less is known about patients who move with a planned transfer of care from one HIV center to another. We assess disease progression in patients who moved and then returned to our care compared with patients remaining or were LTFU.
We identified which patients left our HIV care program between January 01,2000, to January 01,2008, defined how they left (either moved or LTFU), and then determined the health status of returning patients. We examined the impact of the move on their health by comparing clinical measurements (eg, CD4, new AIDS) at their departure and on return.
Forty-four percent of all patients left care; 38% of these returned. In contrast to those remaining in local care whose CD4 counts climbed, "moved" patients exhibited deterioration in both CD4 counts and incident AIDS comparable to LFTU patients. Only 1 in 3 patients who moved had our medical records requested by a new HIV center.
We suspect that despite forward planning, a move may result in potential serious interruptions and/or disengagements of care. The potential harmful health effects can in some be equivalent becoming LTFU. Recognizing and addressing the potential disruption in care from a planned move may be of value in improving outcomes.
关于患者流动性的研究主要集中在那些成为失访（LTFU）的患者上。对于那些计划从一个 HIV 中心转移到另一个中心接受治疗的患者的流动情况，我们知之甚少。我们评估了与留在我们治疗中的患者或 LTFU 患者相比，那些流动后又返回我们治疗中的患者的疾病进展情况。
我们确定了哪些患者在 2000 年 1 月 1 日至 2008 年 1 月 1 日期间离开了我们的 HIV 护理计划，确定了他们离开的方式（转移或 LTFU），然后确定了返回患者的健康状况。我们通过比较他们离开时和返回时的临床测量值（例如 CD4、新发 AIDS）来检查转移对他们健康的影响。
44%的患者离开护理；其中 38%的患者返回。与那些留在当地护理中 CD4 计数上升的患者相比，“转移”患者的 CD4 计数和新发 AIDS 都出现恶化，与 LFTU 患者相似。只有 1/3 的转移患者的医疗记录被新的 HIV 中心要求。
我们怀疑，尽管有前瞻性计划，转移可能会导致潜在的严重中断和/或护理脱节。潜在的健康影响在某些方面可能与成为 LTFU 相当。认识和解决计划转移可能导致的护理中断，可能有助于改善治疗结果。
