考察州级因素对伴有精神分裂症的医疗补助计划参保者进行 HIV 检测的影响。
Examining the Impact of State-Level Factors on HIV Testing for Medicaid Enrollees With Schizophrenia.
机构信息
Department of Epidemiology & Biostatistics, University of California San Francisco, School of Medicine, San Francisco, CA.
Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, San Francisco, CA.
出版信息
J Acquir Immune Defic Syndr. 2023 Sep 1;94(1):18-27. doi: 10.1097/QAI.0000000000003225.
BACKGROUND
People with schizophrenia experience unique barriers to routine HIV testing, despite increased risk of HIV compared with the general US population. Little is known about how health care delivery system factors affect testing rates or whether there are testing differences for people with schizophrenia.
SETTING
Nationally representative sample of Medicaid enrollees with and without schizophrenia.
METHODS
Using retrospective longitudinal data, we examined whether state-level factors were associated with differences in HIV testing among Medicaid enrollees with schizophrenia compared with frequency-matched controls during 2002-2012. Multivariable logistic regression estimated testing rate differences between and within cohorts.
RESULTS
Higher HIV testing rates for enrollees with schizophrenia were associated with higher state-level Medicaid spending per enrollee, efforts to reduce Medicaid fragmentation, and higher federal prevention funding. State-level AIDS epidemiology predicted more frequent HIV testing for enrollees with schizophrenia versus controls. Living in rural settings predicted lower HIV testing, especially for people with schizophrenia.
CONCLUSION
Overall, state-level predictors of HIV testing rates varied among Medicaid enrollees, although rates were generally higher for those with schizophrenia than controls. Increased HIV testing for people with schizophrenia was associated with coverage of HIV testing when medically necessary, higher Centers for Disease Control and Prevention prevention funding, and higher AIDS incidence, prevalence, and mortality when compared with controls. This analysis suggests that state policymaking has an important role to play in advancing that effort. Overcoming fragmented care systems, sustaining robust prevention funding, and consolidating funding streams in innovative and flexible ways to support more comprehensive systems of care delivery deserve attention.
背景
与普通美国人群相比，精神分裂症患者进行常规 HIV 检测存在独特的障碍，尽管他们感染 HIV 的风险增加。对于医疗保健提供系统因素如何影响检测率，或者精神分裂症患者的检测是否存在差异，人们知之甚少。
地点
有和没有精神分裂症的医疗补助受助人的全国代表性样本。
方法
使用回顾性纵向数据，我们研究了在 2002-2012 年期间，州级因素是否与精神分裂症医疗补助受助人的 HIV 检测率与频率匹配的对照组之间的差异相关。多变量逻辑回归估计了队列之间和队列内的检测率差异。
结果
与对照组相比，精神分裂症患者的 HIV 检测率更高，这与每个参保者的州级医疗补助支出较高、减少医疗补助碎片化的努力以及更高的联邦预防资金有关。州级艾滋病流行病学预测了精神分裂症患者比对照组更频繁的 HIV 检测。居住在农村地区预测 HIV 检测率较低，尤其是对精神分裂症患者。
结论
总体而言，HIV 检测率的州级预测因素在医疗补助受助人中有所不同，尽管与对照组相比，精神分裂症患者的检测率通常更高。与对照组相比，当 HIV 检测为医学必需时，扩大 HIV 检测的覆盖面、提高疾病控制与预防中心的预防资金以及提高艾滋病发病率、患病率和死亡率都与精神分裂症患者的 HIV 检测率增加有关。这项分析表明，州政策制定在推进这一工作方面发挥着重要作用。克服碎片化的医疗系统、维持强劲的预防资金以及以创新和灵活的方式整合资金流，以支持更全面的医疗服务提供系统，值得关注。
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