Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa.
Division of Chemical Pathology, Department of Pathology, University of Cape Town, Cape Town, South Africa.
Trop Med Int Health. 2024 Jun;29(6):489-498. doi: 10.1111/tmi.13990. Epub 2024 Mar 21.
OBJECTIVES: Transfers between health facilities of people living with HIV attending primary health care (PHC) including hospital to PHC facility, PHC facility to hospital and PHC facility to PHC facility transfers occur frequently, affect health service planning, and are associated with disengagement from care and viraemia. Data on transfers among people living with diabetes attending PHC, particularly transfers between PHC facilities, are few. We assessed the transfer incidence rate of people living with diabetes attending PHC, and the association between transfers between PHC facilities and subsequent HbA1c values. METHODS: We analysed data on HbA1c tests at public sector facilities in the Western Cape Province (2016-March 2020). Individuals with an HbA1c in 2016-2017 were followed-up for 27 months and included in the analysis if ≥18 years at first included HbA1c, ≥2 HbA1cs during follow-up and ≥1 HbA1c at a PHC facility. A visit interval was the duration between two consecutive HbA1cs. Successive HbA1cs at different facilities of any type indicated any transfer, and HbA1cs at different PHC facilities indicated a transfer between PHC facilities. Mixed effects logistic regression adjusted for sex, age, rural/urban facility attended at the start of the visit interval, disengagement (visit interval >14 months) and a hospital visit during follow-up assessed the association between transfers between PHC facilities and HbA1c >8%. RESULTS: Among 102,813 participants, 22.6% had ≥1 transfer of any type. Including repeat transfers, there were 29,994 transfers (14.4 transfers per 100 person-years, 95% confidence interval [CI] 14.3-14.6). A total of 6996 (30.1%) of those who transferred had a transfer between PHC facilities. Visit intervals with a transfer between PHC facilities were longer (349 days, interquartile range [IQR] 211-503) than those without any transfer (330 days, IQR 182-422). The adjusted relative odds of an HbA1c ≥8% after a transfer between PHC facilities versus no transfer were 1.20 (95% CI 1.05-1.37). CONCLUSION: The volume of transfers involving PHC facilities requires consideration when planning services. Individuals who transfer between PHC facilities require additional monitoring and support.
目的：艾滋病毒感染者在接受基层医疗保健（PHC）时在医疗机构之间转移，包括从医院到 PHC 机构、从 PHC 机构到医院以及从 PHC 机构到 PHC 机构转移，这种情况经常发生，影响卫生服务规划，并与脱离护理和病毒血症有关。关于在接受 PHC 的糖尿病患者之间转移的数据很少，特别是在 PHC 机构之间转移的数据。我们评估了在 PHC 接受治疗的糖尿病患者的转移发生率，以及 PHC 机构之间转移与随后的 HbA1c 值之间的关系。
方法：我们分析了西开普省公立部门设施中 HbA1c 检测数据（2016 年 3 月至 2020 年）。在 2016-2017 年 HbA1c 中具有 HbA1c 的个体，在随访 27 个月后，如果在首次纳入 HbA1c 时年龄≥18 岁、在随访期间进行了≥2 次 HbA1c 检测且在 PHC 机构中进行了≥1 次 HbA1c 检测，则可进行分析。就诊间隔是两次连续 HbA1c 之间的持续时间。不同类型的连续 PHC 机构就诊表示任何转移，而 PHC 机构之间的 HbA1c 就诊表示 PHC 机构之间的转移。混合效应逻辑回归调整了性别、年龄、就诊的城乡 PHC 机构、脱离（就诊间隔>14 个月）和随访期间的医院就诊，评估了 PHC 机构之间转移与 HbA1c>8%之间的关系。
结果：在 102813 名参与者中，有 22.6%有≥1 次任何类型的转移。包括重复转移，共有 29994 次转移（每 100 人年 14.4 次转移，95%置信区间[CI]14.3-14.6）。在那些转移的人中，共有 6996 人（30.1%）有 PHC 机构之间的转移。有 PHC 机构之间转移的就诊间隔较长（349 天，四分位距[IQR]211-503），而无任何转移的就诊间隔较短（330 天，IQR 182-422）。与无 PHC 机构转移相比，在 PHC 机构之间转移后 HbA1c≥8%的调整后相对优势比为 1.20（95%CI1.05-1.37）。
结论：涉及 PHC 机构的转移量在规划服务时需要考虑。在 PHC 机构之间转移的个人需要额外的监测和支持。
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