Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan.
PLoS One. 2013 Jul 29;8(7):e69603. doi: 10.1371/journal.pone.0069603. Print 2013.
Poor retention in the care of patients with human immunodeficiency virus (HIV) is associated with adverse patient outcomes such as antiretroviral therapy failure and death. Therefore, appropriate case management is required for better patient retention; however, which intervention in case management is important has not been fully investigated. Meanwhile, in Japan, each local government is required to organize mental health services for patients with HIV so that a case manager at an HIV care facility can utilize them, but little is known about the association between implementation of the services and loss to follow-up. Therefore, we investigated that by a nested case-control study.
The target population consisted of all patients with HIV who visited Osaka National Hospital, the largest HIV care facility in western Japan, between 2000 and 2010. Loss to follow-up was defined as not returning for follow-up care more than 1 year after the last visit. Independent variables included patient demographics, characteristics of the disease and treatment, and whether the patients have received mental health services. For each case, three controls were randomly selected and matched.
Of the 1620 eligible patients, 88 loss to follow-up cases were identified and 264 controls were matched. Multivariate-adjusted conditional logistic regression revealed that loss to follow-up was less frequent among patients who had received mental health services implemented by their case managers (adjusted odds ratio [95% confidence interval] 0.35 [0.16-0.76]). Loss to follow-up also occurred more frequently in patients who did not receive antiretroviral therapy (adjusted odds ratio [95% confidence interval], 7.51 [3.34-16.9]), who were under 30 years old (2.74 [1.36-5.50]), or who were without jobs (3.38 [1.58-7.23]).
Mental health service implementation by case managers has a significant impact on patient retention.
艾滋病毒（HIV）感染者的治疗保留率较差与抗逆转录病毒治疗失败和死亡等不良患者结局相关。因此，需要适当的病例管理来更好地保留患者；但是，病例管理中哪种干预措施很重要尚未得到充分研究。同时，在日本，每个地方政府都必须为 HIV 患者组织精神卫生服务，以便 HIV 护理机构的病例管理者可以利用这些服务，但对实施这些服务与失访之间的关联知之甚少。因此，我们通过嵌套病例对照研究对此进行了调查。
目标人群包括 2000 年至 2010 年间访问日本西部最大的艾滋病毒护理机构大阪国立医院的所有 HIV 感染者。失访定义为最后一次就诊后超过 1 年未返回进行随访。自变量包括患者人口统计学、疾病和治疗特征以及患者是否接受精神卫生服务。为每个病例随机选择并匹配了 3 个对照。
在 1620 名合格患者中，确定了 88 例失访病例和 264 例对照。多变量调整后的条件逻辑回归显示，接受病例管理者实施的精神卫生服务的患者失访频率较低（调整后的优势比[95%置信区间]0.35[0.16-0.76]）。未接受抗逆转录病毒治疗的患者失访的风险更高（调整后的优势比[95%置信区间]，7.51[3.34-16.9]），年龄在 30 岁以下（2.74[1.36-5.50]）或没有工作（3.38[1.58-7.23]）。
病例管理者实施的精神卫生服务对患者保留率有重大影响。
