Nursing School, Vienna General Hospital, Medical University of Vienna, 1090 Vienna, Austria.
Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria.
Int J Environ Res Public Health. 2023 Feb 15;20(4):3374. doi: 10.3390/ijerph20043374.
Today, antiretroviral therapy (ART) is effectively used as a lifelong therapy to treat people living with HIV (PLWH) to suppress viral replication. Moreover, PLWH need an adequate care strategy in an interprofessional, networked setting of health care professionals from different disciplines. HIV/AIDS poses challenges to both patients and health care professionals within the framework of care due to frequent visits to physicians, avoidable hospitalizations, comorbidities, complications, and the resulting polypharmacy. The concepts of integrated care (IC) represent sustainable approaches to solving the complex care situation of PLWH.
This study aimed to describe the national and international models of integrated care and their benefits regarding PLWH as complex, chronically ill patients in the health care system.
We conducted a narrative review of the current national and international innovative models and approaches to integrated care for people with HIV/AIDS. The literature search covered the period between March and November 2022 and was conducted in the databases Cinahl, Cochrane, and Pubmed. Quantitative and qualitative studies, meta-analyses, and reviews were included.
The main findings are the benefits of integrated care (IC) as an interconnected, guideline- and pathway-based multiprofessional, multidisciplinary, patient-centered treatment for PLWH with complex chronic HIV/AIDS. This includes the evidence-based continuity of care with decreased hospitalization, reductions in costly and burdensome duplicate testing, and the saving of overall health care costs. Furthermore, it includes motivation for adherence, the prevention of HIV transmission through unrestricted access to ART, the reduction and timely treatment of comorbidities, the reduction of multimorbidity and polypharmacy, palliative care, and the treatment of chronic pain. IC is initiated, implemented, and financed by health policy in the form of integrated health care, managed care, case and care management, primary care, and general practitioner-centered concepts for the care of PLWH. Integrated care was originally founded in the United States of America. The complexity of HIV/AIDS intensifies as the disease progresses.
Integrated care focuses on the holistic view of PLWH, considering medical, nursing, psychosocial, and psychiatric needs, as well as the various interactions among them. A comprehensive expansion of integrated care in primary health care settings will not only relieve the burden on hospitals but also significantly improve the patient situation and the outcome of treatment.
如今，抗逆转录病毒疗法（ART）被有效地用作治疗艾滋病毒感染者（PLWH）的终身疗法，以抑制病毒复制。此外，PLWH 需要在跨专业、网络化的医疗保健专业人员网络中采取适当的护理策略，这些专业人员来自不同学科。由于频繁就诊于医生、可避免的住院治疗、合并症、并发症以及由此导致的多药治疗，艾滋病毒/艾滋病给患者和医疗保健专业人员都带来了挑战。综合护理（IC）的概念代表了解决 PLWH 复杂护理情况的可持续方法。
本研究旨在描述国家和国际综合护理模式及其对 PLWH 的益处，因为 PLWH 是医疗保健系统中复杂的慢性病患者。
我们对当前国家和国际创新的综合护理模式和方法进行了叙述性综述，以治疗艾滋病毒/艾滋病患者。文献检索涵盖了 2022 年 3 月至 11 月期间，并在 Cinahl、Cochrane 和 Pubmed 数据库中进行。纳入了定量和定性研究、荟萃分析和综述。
主要发现是综合护理（IC）的好处，它是一种相互关联的、基于指南和路径的多专业、多学科、以患者为中心的治疗方法，适用于患有复杂慢性艾滋病毒/艾滋病的 PLWH。这包括基于证据的护理连续性，减少住院治疗，减少昂贵且繁琐的重复检测，节省整体医疗保健费用。此外，它还包括提高治疗依从性的动机，通过无限制获得抗逆转录病毒治疗来预防艾滋病毒传播，减少和及时治疗合并症，减少多种合并症和多药治疗，姑息治疗以及治疗慢性疼痛。综合护理是通过卫生政策以综合保健、管理式保健、病例和保健管理、初级保健和以全科医生为中心的 PLWH 护理概念的形式发起、实施和资助的。综合护理最初是在美国创立的。随着疾病的进展，艾滋病毒/艾滋病的复杂性加剧。
综合护理侧重于 PLWH 的整体视角，考虑到医疗、护理、心理社会和精神需求，以及它们之间的各种相互作用。在初级保健环境中全面扩大综合护理不仅会减轻医院的负担，还会显著改善患者状况和治疗结果。
