Edmiston Natalie, Petoumenos Kathy, Smith David J
North Coast Sexual Health Services, Lismore, New South Wales, Australia.
The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
Intern Med J. 2018 Jun;48(6):706-713. doi: 10.1111/imj.13733.
Multimorbidity and unplanned admissions are common among people with human immunodeficiency virus (PWH).
To determine factors predictive of unplanned admission among PWH in regional New South Wales and compare care coordination between people with and without unplanned admissions.
A prospective cohort study of PWH attending a regional human immunodeficiency virus (HIV) service was conducted. Baseline HIV-specific results and multimorbidity markers including Cumulative Illness Rating Scale (CIRS) were assessed as predictors of time to first unplanned admission using Cox regression analysis. Care coordination markers were compared between people with and without unplanned admission, using χ statistic for proportions and t-test for means.
A cohort of 181 PWH was followed for a maximum of 5 years. During a total of 739 person-years of follow up, 39 (20.6%) patients reached the endpoint of unplanned admission. In multivariate analysis, the baseline CIRS score was predictive of unplanned admission (P < 0.001). Age, HIV-specific markers and missed visits were not predictive of unplanned admission. For patients with an unplanned admission, discharge summaries were documented for 22/39 (56.4%). Of 180 PWH with a visit after baseline, 131 (72.8%) had a letter to a general practitioner and 79 (43.7%) had two or more prescribers. Having two or more prescribers was more common in people with an unplanned admission than in those without (64.1% vs 38.0%, P = 0.004).
Unplanned admission among PWH is predicted by multimorbidity. Care for PWH should include coordinated management of other health conditions in order to reduce their severity and prevent unplanned admissions.
多重疾病和非计划住院在人类免疫缺陷病毒（HIV）感染者（PWH）中很常见。
确定新南威尔士州地区PWH中非计划住院的预测因素，并比较有和没有非计划住院的患者之间的护理协调情况。
对在地区性人类免疫缺陷病毒（HIV）服务机构就诊的PWH进行前瞻性队列研究。使用Cox回归分析评估基线HIV特异性结果和包括累积疾病评定量表（CIRS）在内的多重疾病标志物，作为首次非计划住院时间的预测因素。使用χ²检验比较有和没有非计划住院的患者之间的护理协调标志物比例，使用t检验比较均值。
对181名PWH队列进行了最长5年的随访。在总共739人年的随访期间，39名（20.6%）患者达到了非计划住院的终点。在多变量分析中，基线CIRS评分可预测非计划住院（P < 0.001）。年龄、HIV特异性标志物和漏诊均不能预测非计划住院。对于非计划住院的患者，22/39（56.4%）有出院小结记录。在基线后就诊的180名PWH中，131名（72.8%）收到了给全科医生的信，79名（43.7%）有两名或更多开处方者。有两名或更多开处方者在非计划住院患者中比在无此情况的患者中更常见（64.1%对38.0%，P = 0.004）。
多重疾病可预测PWH的非计划住院。对PWH的护理应包括对其他健康状况的协调管理，以减轻其严重程度并预防非计划住院。
