Grant Conor, Bergin Colm, O'Connell Sarah, Cotter John, Ní Cheallaigh Clíona
St James's Hospital, Dublin, Ireland.
Trinity College, Dublin, Ireland.
Open Forum Infect Dis. 2020 Jan 31;7(2):ofaa037. doi: 10.1093/ofid/ofaa037. eCollection 2020 Feb.
High-cost, high-need users are defined as patients who accumulate large numbers of emergency department visits and hospital admissions that might have been prevented by relatively inexpensive early interventions and primary care. This phenomenon has not been previously described in HIV-infected individuals.
We analyzed the health records of HIV-infected individuals using scheduled or unscheduled inpatient or outpatient health care in St James's Hospital, Dublin, Ireland, from October 2014 to October 2015.
Twenty-two of 2063 HIV-infected individuals had a cumulative length of stay >30 days in the study period. These individuals accrued 99 emergency department attendances and 1581 inpatient bed days, with a direct cost to the hospital of >€1 million during the study period. Eighteen of 22 had potentially preventable requirements for unscheduled care. Two of 18 had a late diagnosis of HIV. Sixteen of 18 had not been successfully engaged in outpatient HIV care and presented with consequences of advanced HIV. Fourteen of 16 of those who were not successfully engaged in care had ≥1 barrier to care (addiction, psychiatric disease, and/or homelessness).
A small number of HIV-infected individuals account for a high volume of acute unscheduled care. Intensive engagement in outpatient care may prevent some of this usage and ensuing costs.
高成本、高需求使用者被定义为那些积累了大量急诊科就诊和住院次数的患者，而这些情况本可通过相对廉价的早期干预和初级保健得以预防。此前尚未在HIV感染者中描述过这种现象。
我们分析了2014年10月至2015年10月在爱尔兰都柏林圣詹姆斯医院接受定期或不定期住院或门诊医疗保健的HIV感染者的健康记录。
在研究期间，2063名HIV感染者中有22人累计住院时间超过30天。这些人累计就诊急诊科99次，住院1581天，研究期间给医院造成的直接费用超过100万欧元。22人中有18人对不定期护理有潜在可预防的需求。18人中有2人HIV诊断较晚。18人中有16人未成功接受门诊HIV护理，并出现了晚期HIV的后果。未成功接受护理的16人中有14人存在≥1种护理障碍（成瘾、精神疾病和/或无家可归）。
少数HIV感染者占用了大量急性不定期护理资源。加强门诊护理可能会预防部分此类使用情况及随之产生的费用。
