Faculty of Medicine, Graduate Programs in Rehabilitation Sciences, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, Canada.
British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
Soc Psychiatry Psychiatr Epidemiol. 2019 Sep;54(9):1153-1159. doi: 10.1007/s00127-019-01693-y. Epub 2019 Mar 22.
Leaving hospital against medical advice (AMA) is a significant source of morbidity, mortality, and a major burden to the healthcare system. Studies have indicated that marginalized populations, including people living with HIV (PLHIV) and those living with a personality disorder (PD), experience high hospitalization rates. We sought to identify whether being diagnosed with a PD was associated with leaving hospital AMA among PLHIV in British Columbia (BC), Canada.
Data were derived from the STOP HIV/AIDS in BC cohort, a provincial-level linkage of a series of surveillance, laboratory, and health administrative databases of all identified PLHIV in BC. Using multivariable generalized estimating equations (GEE), we examined the relationship between diagnoses of PD and premature hospital discharge among PLHIV.
Among 8763 PLHIV included in the study sample, 1321 (15%) were diagnosed with a PD. The prevalence of leaving hospital AMA at least once during the study period was 9%. In multivariable GEE analyses, after adjusting for a range of demographic and clinical confounders, there remained a positive association between being diagnosed with a PD and leaving hospital prematurely. Results showed a significant and independent association between a PD diagnosis and leaving AMA among PLHIV.
These findings underscore the importance of identifying and addressing specific PD-related behaviour which negatively impact inpatient treatment completion among this subpopulation of PLHIV. Furthermore, these findings suggest a need to develop novel health system interventions to minimize AMA discharge among this population.
未经医嘱擅自出院是发病率、死亡率的重要来源，也是医疗系统的主要负担。研究表明，包括艾滋病毒感染者（PLHIV）和有人格障碍（PD）的人群在内的边缘化人群住院率较高。我们试图确定在加拿大不列颠哥伦比亚省（BC），被诊断患有 PD 是否与 PLHIV 未经医嘱擅自出院有关。
数据来自 STOP HIV/AIDS in BC 队列，这是不列颠哥伦比亚省一系列监测、实验室和卫生行政数据库的省级链接，用于识别所有确诊的 PLHIV。我们使用多变量广义估计方程（GEE），研究 PD 诊断与 PLHIV 提前出院之间的关系。
在纳入研究样本的 8763 名 PLHIV 中，有 1321 名（15%）被诊断患有 PD。在研究期间至少有一次未经医嘱擅自出院的比例为 9%。在多变量 GEE 分析中，在调整了一系列人口统计学和临床混杂因素后，PD 诊断与提前出院之间仍存在正相关。结果显示，PD 诊断与 PLHIV 未经医嘱擅自出院之间存在显著的独立关联。
这些发现强调了识别和解决特定 PD 相关行为的重要性，这些行为会对这一特定 PLHIV 亚群的住院治疗完成产生负面影响。此外，这些发现表明需要开发新的卫生系统干预措施，以减少这一人群中未经医嘱擅自出院的情况。
