医疗保健融资对 HIV 感染者心血管疾病预防的影响。
The influence of healthcare financing on cardiovascular disease prevention in people living with HIV.
机构信息
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
Duke University School of Medicine, Durham, NC, USA.
出版信息
BMC Public Health. 2020 Nov 23;20(1):1768. doi: 10.1186/s12889-020-09896-8.
BACKGROUND
People living with HIV are diagnosed with age-related chronic health conditions, including cardiovascular disease, at higher than expected rates. Medical management of these chronic health conditions frequently occur in HIV specialty clinics by providers trained in general internal medicine, family medicine, or infectious disease. In recent years, changes in the healthcare financing for people living with HIV in the U.S. has been dynamic due to changes in the Affordable Care Act. There is little evidence examining how healthcare financing characteristics shape primary and secondary cardiovascular disease prevention among people living with HIV. Our objective was to examine the perspectives of people living with HIV and their healthcare providers on how healthcare financing influences cardiovascular disease prevention.
METHODS
As part of the EXTRA-CVD study, we conducted in-depth, semi-structured interviews with 51 people living with HIV and 34 multidisciplinary healthcare providers and at three U.S. HIV clinics in Ohio and North Carolina from October 2018 to March 2019. Thematic analysis using Template Analysis techniques was used to examine healthcare financing barriers and enablers of cardiovascular disease prevention in people living with HIV.
RESULTS
Three themes emerged across sites and disciplines (1): healthcare payers substantially shape preventative cardiovascular care in HIV clinics (2); physician compensation tied to relative value units disincentivizes cardiovascular disease prevention efforts by HIV providers; and (3) grant-based services enable tailored cardiovascular disease prevention, but sustainability is limited by sponsor priorities.
CONCLUSIONS
With HIV now a chronic disease, there is a growing need for HIV-specific cardiovascular disease prevention; however, healthcare financing complicates effective delivery of this preventative care. It is important to understand the effects of evolving payer models on patient and healthcare provider behavior. Additional systematic investigation of these models will help HIV specialty clinics implement cardiovascular disease prevention within a dynamic reimbursement landscape.
TRIAL REGISTRATION
Clinical Trial Registration Number: NCT03643705 .
背景
患有艾滋病的人群被诊断出患有与年龄相关的慢性健康问题，包括心血管疾病，其发病率高于预期。这些慢性健康问题的医疗管理通常由接受过普通内科、家庭医学或传染病学培训的提供者在艾滋病专科诊所进行。近年来，由于《平价医疗法案》的变化，美国艾滋病患者的医疗保健融资情况发生了动态变化。几乎没有证据表明医疗保健融资特征如何影响艾滋病患者的一级和二级心血管疾病预防。我们的目标是研究艾滋病患者及其医疗保健提供者如何看待医疗保健融资对心血管疾病预防的影响。
方法
作为 EXTRA-CVD 研究的一部分，我们于 2018 年 10 月至 2019 年 3 月在俄亥俄州和北卡罗来纳州的三家美国艾滋病诊所，对 51 名艾滋病患者和 34 名多学科医疗保健提供者进行了深入的半结构化访谈。采用模板分析技术的主题分析被用于研究艾滋病患者心血管疾病预防的医疗保健融资障碍和促进因素。
结果
三个主题在各个地点和学科中都有出现：（1）医疗保健支付者极大地影响了艾滋病诊所的预防性心血管护理；（2）与相对价值单位挂钩的医生薪酬会抑制艾滋病提供者进行心血管疾病预防工作；（3）基于赠款的服务可以实现有针对性的心血管疾病预防，但可持续性受到赞助商优先事项的限制。
结论
随着艾滋病现在成为一种慢性病，对艾滋病特异性心血管疾病预防的需求日益增长；然而，医疗保健融资使这种预防性护理的有效实施变得复杂。了解不断变化的支付者模式对患者和医疗保健提供者行为的影响非常重要。对这些模式的进一步系统研究将有助于艾滋病专科诊所在动态报销环境中实施心血管疾病预防。
试验注册
临床试验注册号：NCT03643705。
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