Department of Medicine, Emory University School of Medicine, Atlanta, GA.
Currently, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
J Acquir Immune Defic Syndr. 2020 May 1;84(1):78-84. doi: 10.1097/QAI.0000000000002296.
Early palliative care addresses biopsychosocial needs for people living with HIV in an outpatient setting. We sought to describe patients referred to a palliative care program and compare the medical outcomes of emergency department (ED) visits, hospitalizations, primary care visits, and viral load suppression among patients enrolled in the program, to patients who did not enroll (no-show group).
We completed a retrospective cohort study at an urban, academically affiliated HIV primary care clinic.
Data were collected from electronic medical records. Descriptive statistics characterized patient demographics at baseline, comorbidities, and reasons for referral to palliative care. Viral load suppression, rates of ED visits, hospitalizations, primary care visits, and retention in care were compared between the palliative and no-show groups.
The most common reasons for referral were chronic pain management and medication/appointment adherence. Median percent of viral load measurements suppressed increased over time, but did not differ statistically between groups (pre: 28.6% and 15.5%, post: 70.8% and 50.0%, palliative and no-show groups, respectively). Median rates of ED visits and hospitalizations were low and were not impacted by palliative care. Rates of primary care visit attendance remained stable in the palliative group (4.6/year) but declined in the no-show group (3.5/year), P < 0.05. Retention in care improved significantly after the palliative intervention (palliative: 85.4%-96.1%, no-show: 94.4%-82.5%), and at high and low palliative engagement, suggesting a threshold effect of the intervention.
Outpatient early palliative care is a promising intervention that might impact retention in HIV care.
早期姑息治疗可满足门诊环境中艾滋病毒感染者的身心社会需求。我们旨在描述转介至姑息治疗项目的患者，并比较参与该项目患者与未参与患者（失访组）的急诊就诊、住院、初级保健就诊和病毒载量抑制的医疗结局。
我们在一家城市性、学术附属的艾滋病毒初级保健诊所完成了一项回顾性队列研究。
数据从电子病历中收集。描述性统计分析了基线时患者的人口统计学特征、合并症和转介至姑息治疗的原因。姑息治疗组和失访组之间比较了病毒载量抑制率、急诊就诊率、住院率、初级保健就诊率和维持治疗率。
转介的最常见原因是慢性疼痛管理和药物/预约遵医嘱情况。病毒载量测量值的中位数抑制百分比随时间推移而增加，但组间无统计学差异（分别为治疗前：28.6%和 15.5%，治疗后：70.8%和 50.0%）。急诊就诊和住院的中位数率较低，且不受姑息治疗的影响。姑息治疗组的初级保健就诊率保持稳定（4.6/年），但失访组下降（3.5/年），P<0.05。姑息治疗干预后，维持治疗率显著提高（姑息治疗：85.4%-96.1%，失访：94.4%-82.5%），且在高和低姑息治疗参与度时均如此，提示干预存在阈值效应。
门诊早期姑息治疗是一种有前途的干预措施，可能对艾滋病毒维持治疗有影响。
