Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada.
J Acquir Immune Defic Syndr. 2012 Jun 1;60(2):173-82. doi: 10.1097/QAI.0b013e31824bd55d.
Prompt linkage to HIV primary care may reduce the need for inpatient hospitalization.
Retrospective cohort study of South Carolina HIV-infected individuals diagnosed from January 1986 to December 2006 who utilized 62 inpatient facilities from (January 2007 to June 2010). Suboptimal primary care engagement was defined as <2 reports of a CD4T-cell count or viral load value to surveillance in each calendar year from January 2007 to June 2010. Multivariable logistic regression explored associations of HIV primary care engagement with inpatient hospitalization after accounting for sociodemographic characteristics and disease stage. Poisson and negative binominal regression examined primary care engagement, sociodemographic characteristics, and disease stage on frequency of inpatient hospitalization and total inpatient days.
Individuals presenting to the hospital with an AIDS-defining illness had greater risk of suboptimal HIV primary care engagement [adjusted odds ratio (aOR) = 1.58; 95% confidence interval (CI): 1.23 to 2.04] more inpatient hospitalizations (incidence rate ratio [IRR] = 1.74; 95% CI: 1.65 to 1.83) and inpatient days (IRR = 2.17; 95%CI: 2.00 to 2.36). Blacks demonstrated greater suboptimal care risk (aOR = 1.61; 95% CI: 1.15 to 2.25), more inpatient visits (IRR = 1.09; 95% CI: 1.01 to 1.17), and inpatient days (IRR = 1.21; 95% CI: 1.09 to 1.34). Medicare protected against suboptimal primary care engagement (aOR = 0.66; 95% CI: 0.46 to 0.95) but was associated with more hospitalizations (IRR = 1.09; 95% CI: 1.01 to 1.18). AIDS disease stage was associated with decreased suboptimal care risk (AIDS ≤ 1 year, aOR = 0.05; 95% CI: 0.02 to 0.12; AIDS > 1 year, aOR = 0.11; 95% CI: 0.06 to 0.20) but more hospitalizations (AIDS ≤1 year, IRR = 1.12; 95% CI: 1.04 to 1.21; AIDS > 1 year, IRR = 1.12; 95% CI: 1.04 to 1.21) and inpatient days (AIDS ≤ 1 year, IRR = 1.22; 95% CI: 1.08 to 1.37; AIDS >1 year, IRR = 1.35; 95% CI: 1.21 to 1.50).
Disease stage, race, and insurance status strongly influence HIV primary care engagement and inpatient hospitalization. Admissions may be related to general medical conditions, substance abuse, or antiretroviral therapy.
及时将艾滋病毒感染者转入初级保健机构可能会减少住院治疗的需要。
对 1986 年 1 月至 2006 年 12 月期间在南卡罗来纳州被诊断为艾滋病毒感染的个体进行回顾性队列研究，这些个体在 2007 年 1 月至 2010 年 6 月期间使用了 62 家住院设施。未充分参与初级保健的定义为，在 2007 年 1 月至 2010 年 6 月的每个日历年中，向监测机构报告的 CD4T 细胞计数或病毒载量值<2 次。多变量逻辑回归分析了在考虑社会人口统计学特征和疾病分期的情况下，艾滋病毒初级保健参与与住院治疗之间的关系。泊松和负二项回归分析了初级保健参与、社会人口统计学特征和疾病分期对住院频率和总住院天数的影响。
患有艾滋病定义性疾病的个体更有可能未充分参与艾滋病毒初级保健（调整后的优势比[aOR] = 1.58；95%置信区间[CI]：1.23 至 2.04），需要更多的住院治疗（发病率比[IRR] = 1.74；95%CI：1.65 至 1.83）和住院天数（IRR = 2.17；95%CI：2.00 至 2.36）。黑人表现出更高的未充分护理风险（aOR = 1.61；95%CI：1.15 至 2.25），更多的住院就诊（IRR = 1.09；95%CI：1.01 至 1.17）和住院天数（IRR = 1.21；95%CI：1.09 至 1.34）。医疗保险可预防未充分参与初级保健（aOR = 0.66；95%CI：0.46 至 0.95），但与更多的住院治疗相关（IRR = 1.09；95%CI：1.01 至 1.18）。艾滋病分期与降低未充分护理风险相关（艾滋病≤1 年，aOR = 0.05；95%CI：0.02 至 0.12；艾滋病>1 年，aOR = 0.11；95%CI：0.06 至 0.20），但与更多的住院治疗相关（艾滋病≤1 年，IRR = 1.12；95%CI：1.04 至 1.21；艾滋病>1 年，IRR = 1.12；95%CI：1.04 至 1.21）和住院天数（艾滋病≤1 年，IRR = 1.22；95%CI：1.08 至 1.37；艾滋病>1 年，IRR = 1.35；95%CI：1.21 至 1.50）。
疾病分期、种族和保险状况强烈影响艾滋病毒初级保健的参与度和住院治疗。入院可能与一般医疗条件、药物滥用或抗逆转录病毒治疗有关。
