Colubi María Martínez, Pérez-Elías María Jesús, Elías Laura, Pumares María, Muriel Alfonso, Zamora Ana Moreno, Casado Jose Luis, Dronda Fernando, López Dolores, Moreno Santiago
Infectious Diseases Department, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Ramón y Cajal Hospital, Madrid, Spain.
HIV Clin Trials. 2012 Sep-Oct;13(5):289-95. doi: 10.1310/hct1305-289.
INTRODUCTION: It is not uncommon for patients with HIV infection to miss scheduled visits in outpatient clinics without justifying the failure to appear or reschedule the appointment. Few studies have assessed the impact of inconsistent follow-ups on resource use and disease outcomes in this patient population. OBJECTIVE: To assess the effect of missing scheduled visits to the outpatient clinic on the health outcomes of HIV-infected patients. METHODS: Between January and June 2006, we conducted a prospective observational study monitoring assistance at an outpatient HIV/AIDS clinic of a tertiary hospital within a public health care system in a developed country. The short-term subsequent events (deaths and admissions) of the population were observed from January to December 2006. RESULTS: Of the 1,733 HIV patients who were scheduled in the outpatient clinic, 103 met the criteria of missing scheduled visit (5.9%). Hospital admissions and mortality rates were significantly higher in the missing scheduled visit group compared to non-missing scheduled visits (27.2% vs 8.9%; P < .001 and 5.8% vs 0.7%; P < .001, respectively). Patients with missing scheduled visits had a higher risk of hospital admissions (odds ratio [OR] 2.4; 95% CI, 1.4-4) and mortality (OR 6.7; 95% CI, 2.2-18.5) adjusted by age, CD4 cell count, HIV stage, and category of transmission. CONCLUSIONS: Missing scheduled visits was an independent predicting factor for hospital admission and mortality. It is warranted to monitor and implement resources to reduce missed appointments.
引言:感染艾滋病毒的患者错过门诊预定就诊时间且未对未就诊或重新安排预约给出合理理由的情况并不少见。很少有研究评估这种随访不一致对该患者群体资源利用和疾病结局的影响。 目的:评估错过门诊预定就诊对艾滋病毒感染患者健康结局的影响。 方法:2006年1月至6月期间,我们在一个发达国家公共卫生保健系统内的一家三级医院的艾滋病毒/艾滋病门诊进行了一项前瞻性观察性研究,监测相关援助情况。观察了该人群在2006年1月至12月期间的短期后续事件(死亡和入院情况)。 结果:在门诊预定就诊的1733名艾滋病毒患者中,103名符合错过预定就诊的标准(5.9%)。与未错过预定就诊的患者相比,错过预定就诊组的住院率和死亡率显著更高(分别为27.2%对8.9%;P <.001以及5.8%对0.7%;P <.001)。经年龄、CD4细胞计数、艾滋病毒分期和传播类别调整后,错过预定就诊的患者住院风险更高(比值比[OR] 2.4;95%置信区间,1.4 - 4),死亡风险也更高(OR 6.7;95%置信区间,2.2 - 18.5)。 结论:错过预定就诊是住院和死亡的独立预测因素。有必要监测并实施相关资源措施以减少预约失约情况。
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