Le Doare Kirsty, Mackie N E, Kaye S, Bamford A, Walters S, Foster C
St. Mary's Hospital, Imperial College NHS Trust, London, UK Department of Paediatrics, Imperial College London, London, UK.
St. Mary's Hospital, Imperial College NHS Trust, London, UK.
Arch Dis Child. 2015 Jun;100(6):527-31. doi: 10.1136/archdischild-2014-307019. Epub 2014 Dec 30.
The objective of this study is to review clinical outcomes of recommendations made by a multidisciplinary paediatric virtual clinic (PVC) for complex case management of paediatric HIV as a model of care within a tertiary network.
A retrospective review of the clinical outcomes of paediatric and adolescent (0-21 years) referrals to the PVC at St. Mary's Hospital, Imperial College Healthcare NHS Trust, London was performed between October 2009 and November 2013.
234 referrals were made for 182 children from 37 centres, discussed in 42 meetings (median age 13 years, IQR 10-15 years). Reasons for referral included virological failure (44%), simplification of the current regimen (24%) and antiretroviral drug complications (24%). At latest follow-up, PVC advice had been instituted in 80% of referrals. Suppression following virological failure was achieved in 48% following first referral and 57% following subsequent discussions and was maintained in 95% of children referred for regimen simplification. Following advice, dyslipidaemia resolved in 42% and liver function normalised in 73% with biochemical hepatitis. Adherence support aided resolution of viraemia in nine children and 12% of referrals resulted in additional support, including psychology, social services and mental health input.
Combined multidisciplinary virtual input with adult expertise in resistance and newer agents, paediatric knowledge of pill swallowing, childhood formulations/weight banding and parental support, assists complex treatment decision making in paediatric HIV infection. The Virtual Clinic model could be applied to the management of other rare complex diseases of childhood within a clinical network.
本研究旨在回顾多学科儿科虚拟诊所（PVC）针对儿科艾滋病毒复杂病例管理所提出建议的临床结果，将其作为三级医疗网络内的一种护理模式。
对2009年10月至2013年11月期间转诊至伦敦帝国学院医疗保健国民信托基金圣玛丽医院PVC的儿科和青少年（0至21岁）患者的临床结果进行回顾性分析。
来自37个中心的182名儿童共转诊234次，在42次会议上进行了讨论（中位年龄13岁，四分位间距10至15岁）。转诊原因包括病毒学失败（44%）、简化当前治疗方案（24%）和抗逆转录病毒药物并发症（24%）。在最近一次随访时，80%的转诊病例采纳了PVC的建议。首次转诊后病毒学失败后实现病毒抑制的比例为48%，后续讨论后为57%，对于转诊以简化治疗方案的儿童，95%的儿童维持了病毒抑制。接受建议后，42%的血脂异常得到缓解，73%患有生化性肝炎的儿童肝功能恢复正常。依从性支持帮助9名儿童解决了病毒血症问题，12%的转诊病例获得了额外支持，包括心理学、社会服务和心理健康方面的投入。
多学科虚拟投入与成人在耐药性和新型药物方面的专业知识、儿科在吞服药物、儿童剂型/体重分组方面的知识以及家长支持相结合，有助于儿科艾滋病毒感染的复杂治疗决策。虚拟诊所模式可应用于临床网络内其他儿童罕见复杂疾病的管理。
