Cunningham W E, Mosen D M, Hays R D, Andersen R M, Shapiro M F
Department of Medicine, School of Medicine, University of California, Los Angeles 90024, USA.
J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Dec 1;13(4):327-35. doi: 10.1097/00042560-199612010-00005.
To assess whether better access to community-based outpatient medical services was associated with fewer HIV-related hospitalizations, we studied 217 patients hospitalized at seven southern California hospitals. During hospital admission, patients completed an interview that included one item about the reported difficulty or ease of access to community-based medical services prior to their first hospitalization for HIV-related illness. After discharge, medical records were abstracted for data on prior hospitalizations. CD4 counts, and illness severity. About one-half of patients reported that medical services were readily accessible. Medical records revealed that since the time of HIV infection 49% had two or more total hospitalizations (mean = 2. SD = 2). In multiple logistic regression analysis, better reported access to services was significantly associated with not having been hospitalized (vs. having been hospitalized) over the same time period (OR = 0.73, 95% CI = 0.55-0.97), controlling for CD4 count, illness severity, duration of diagnosed HIV infection, having a regular source of care, type of hospital care, insurance coverage, and other patient characteristics. Improving access to community-based medical services for ambulatory HIV-infected patients may help to avert costly hospital care. Prospective studies are needed to assess whether a causal relationship between greater community-based access and reduced hospitalizations exists and, if so, whether community-based services may be cost-effective substitutes for hospital HIV care.
为评估获得更好的社区门诊医疗服务是否与减少与艾滋病病毒相关的住院治疗有关，我们研究了在南加州七家医院住院的217名患者。在住院期间，患者完成了一项访谈，其中包括一个关于首次因艾滋病病毒相关疾病住院之前获得社区医疗服务的难易程度的问题。出院后，提取病历以获取既往住院、CD4细胞计数和疾病严重程度的数据。约一半的患者报告称医疗服务很容易获得。病历显示，自感染艾滋病病毒以来，49%的患者总共住院两次或更多次（平均=2，标准差=2）。在多因素逻辑回归分析中，在控制CD4细胞计数、疾病严重程度、确诊艾滋病病毒感染的持续时间、有固定的医疗来源、医院护理类型、保险覆盖范围和其他患者特征的情况下，报告的更好的服务可及性与同期未住院（与已住院相比）显著相关（比值比=0.73，95%置信区间=0.55-0.97）。改善门诊艾滋病病毒感染患者获得社区医疗服务的机会可能有助于避免昂贵的住院治疗。需要进行前瞻性研究，以评估社区服务可及性提高与住院治疗减少之间是否存在因果关系，如果存在，基于社区的服务是否可能是艾滋病病毒住院治疗的具有成本效益的替代方案。
