Norberg Andrea, Nelson John, Holly Cheryl, Jewell Sarah T, Lieggi Michelle, Salmond Susan
School of Nursing, Rutgers, The State University of New Jersey, Newark, USA.
The François Xavier Bagnoud Center, Rutgers, The State University of New Jersey, Newark, USA.
JBI Database System Rev Implement Rep. 2019 Jun;17(6):1154-1228. doi: 10.11124/JBISRIR-2017-003756.
The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a major public health problem that has claimed the lives of more than 34 million people worldwide. The health of people living with HIV (PLWH) is optimized by ongoing engagement in HIV care, yet many people living with HIV either do not enter or fall out of care. Access to care and ongoing engagement in care for antiretroviral (ARV) medication adherence and psychoeducational support are critical to achieving the desired outcomes of reducing the risk of further HIV transmission and HIV related morbidity and mortality, and managing other commonly co-occurring health, social and behavioral conditions, thereby maximizing wellness.
The objective of the review was to identify, evaluate and synthesize existing qualitative evidence on the experiences of HIV-infected adults with healthcare systems/practices/processes, and the experiences of healthcare providers with healthcare systems/practices/processes that impact engagement in primary healthcare settings in the United States (US).
The review included studies reporting on the qualitative experiences of HIV-infected adults, aged 18-65 years, with healthcare systems, practices and processes and their healthcare providers (physicians, nurses and others providing care to these patients in the primary care healthcare setting). Qualitative studies including but not limited to designs such as phenomenology, ethnography, grounded theory, action research and qualitative descriptive were included. Studies published in languages other than English and conducted outside of the US were excluded.
Using a three-step search strategy, databases of published and unpublished articles were searched from 1997 to 2017. All included studies were assessed by two independent reviewers for methodological quality, and data was extracted and pooled using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Findings were rated according to their level of credibility, categorized based on similarity in meaning and subjected to a meta-synthesis.
A total of 1038 qualitative articles were identified of which 41 were included after critical appraisal. Meta-synthesis generated four synthesized findings: i) What I want from my provider: to be a respectful, empathetic and holistic partner in my care; ii) I cannot do it alone: the critical importance of actively guiding and assisting patients during transitions and securing the needed resources; iii) Help me to understand my illness and care needs; iv) One-stop care that is de-stigmatizing and welcoming to diverse cultures keeps clients in care. These synthesized findings were derived from 243 study findings that were subsequently aggregated into 19 categories. Of the 243 study findings, 240 were rated unequivocal and three were rated credible. The overall ConQual for each of the four synthesized findings was moderate due to common dependability issues across the included studies. A total of 1597 participants were included. Only two studies were included from 1997 to 2000. The majority of included studies were published from 2005 to 2017.
The synthesized findings illustrate clear quality indicators for primary care practice, emphasizing the patient-provider-care team partnership and shared decision making that is holistic, takes into account a patient's whole life, responsibilities and stressors, and reframes HIV associated misperceptions/myths. The review also highlights the importance of helping patients navigate and interact with the healthcare system by offering one-stop services that assist with multiple medical care needs and "wraparound" services that provide the needed care coordination to assist with critical quality of life needs such as food, housing, transportation, and assistance with applying for health insurance and medication.
人类免疫缺陷病毒/获得性免疫缺陷综合征（HIV/AIDS）是一个重大的公共卫生问题，全球已有超过3400万人因此丧生。持续接受HIV治疗可优化HIV感染者（PLWH）的健康状况，但许多HIV感染者要么未接受治疗，要么中途退出治疗。获得治疗以及持续参与抗逆转录病毒（ARV）药物治疗依从性和心理教育支持的护理，对于实现降低HIV进一步传播风险、与HIV相关的发病率和死亡率的预期结果，以及管理其他常见的健康、社会和行为状况，从而最大限度地提高健康水平至关重要。
本综述的目的是识别、评估和综合现有的定性证据，这些证据涉及美国HIV感染成年人在医疗保健系统/实践/流程中的经历，以及医疗保健提供者在影响初级医疗保健机构参与度的医疗保健系统/实践/流程中的经历。
本综述纳入了报告18至65岁HIV感染成年人在医疗保健系统、实践和流程以及他们的医疗保健提供者（医生、护士和在初级医疗保健机构为这些患者提供护理的其他人）方面的定性经历的研究。包括但不限于现象学、民族志、扎根理论、行动研究和定性描述等设计的定性研究。排除以英语以外的语言发表且在美国境外进行的研究。
采用三步搜索策略，检索了1997年至2017年已发表和未发表文章的数据库。所有纳入研究均由两名独立评审员评估方法学质量，并使用乔安娜·布里格斯研究所信息统一管理、评估和综述系统（JBI SUMARI）提取和汇总数据。根据其可信度水平对研究结果进行评级，根据意义的相似性进行分类，并进行元综合分析。
共识别出1038篇定性文章，经过严格评估后纳入41篇。元综合分析得出了四个综合研究结果：i）我希望从我的医疗服务提供者那里得到的：在我的护理中成为一个尊重、有同理心且全面的伙伴；ii）我无法独自完成：在过渡期间积极指导和协助患者并确保所需资源的至关重要性；iii）帮助我了解我的病情和护理需求；iv）一站式护理，消除耻辱感并欢迎不同文化，使患者持续接受护理。这些综合研究结果源自243项研究结果，随后汇总为19个类别。在243项研究结果中，240项被评为明确无误，3项被评为可信。由于纳入研究中普遍存在可靠性问题，四个综合研究结果的总体ConQual评分为中等。总共纳入了1597名参与者。1997年至2000年期间仅纳入了两项研究。大多数纳入研究发表于2005年至2017年。
综合研究结果阐明了初级医疗保健实践的明确质量指标，强调了患者 - 医疗服务提供者 - 护理团队的伙伴关系以及共同决策，这种决策是全面的，考虑到患者的整个生活、责任和压力源，并重塑与HIV相关的误解/神话。该综述还强调了通过提供满足多种医疗需求的一站式服务以及提供所需护理协调以满足诸如食物、住房、交通以及申请医疗保险和药物援助等关键生活质量需求的“全方位”服务，帮助患者在医疗保健系统中导航和互动的重要性。
