The association of provider and practice factors with HIV antiretroviral therapy adherence.
The association of provider and practice factors with HIV antiretroviral therapy adherence.
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提供者和实践因素与 HIV 抗逆转录病毒治疗依从性的关联。
DOI：
10.1097/qad.0000000000002316
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Wilson,IraB
中科院分区：
文献类型：
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作者：
Meyers,DavidJ;Cole,MeganB;Rahman,Momotazur;Lee,Yoojin;Rogers,William;Gutman,Roee;Wilson,IraB
目的：虽然抗逆转录病毒治疗 (ART) 对于 HIV 患者至关重要，但全国范围内的依从性存在很大差异。我们评估提供者和实践因素如何有助于成功遵守 HIV ART。设计：我们使用 2008 年至 2012 年的 Medicaid Analytic Extract 声明。我们将 HIV 患者归因于在特定年份提供多种 HIV 相关服务或初级保健的提供者，并根据国家提供者标识符注册表文件将这些提供者分配给医疗实践。我们将连续的线性分层模型与患者、提供者和实践特征进行拟合，以划分每个因素驱动的依从性变化。我们的分析单位是患者年。背景：美国 HIV 患病率最高的 14 个州。参与者：总共 111 013 名患者年，代表 60 496 名携带 HIV 的医疗补助参保者，涉及 4930 名医疗服务提供者和 1960 家诊所。主要结果指标：每年个体患者遵守 ART 治疗方案的百分比。结果：医疗服务提供者和医疗实践的随机效应共同解释了 6.8% 的变异患者依从性差异占差异的 45.2%。与传染病专家接诊的患者相比，通才和其他专家接诊的患者的依从性分别高出 1.6 [95% 置信区间 (CI)：0.6–2.5] 和 5.1 (95% CI：4.1–6.1) 个百分点 (P< 0.001)。每多一年，患者看同一提供者的依从性就会增加 6%（95% CI：5.7-6.3）。结论：ART 依从性因提供者和实践以及提供者专业之间而存在很大差异。为了提高艾滋病毒感染者的抗逆转录病毒治疗依从性，应考虑护理的结构方面。
Objective:While antiretroviral therapy (ART) is essential to patients with HIV, there is substantial variation in adherence nationally. We assess how provider and practice factors contribute to successful HIV ART adherence.Design:We used Medicaid Analytic Extract claims from 2008 to 2012. We attributed patients with HIV to the provider that provided the plurality of HIV-related services or primary care in a given year and assigned these providers to a medical practice based on the National Provider Identifier registry file. We fit successive linear hierarchical models with patient, provider, and practice characteristics to partition the variation in adherence driven by each factor. Our unit of analysis was the patient-year.Setting:Fourteen US states with the highest HIV prevalence.Participants:A total of 111 013 patient-years representing 60 496 Medicaid enrollees living with HIV attributed to 4930 providers and 1960 practices.Main outcome measure:Percentage of year individual patients were adherent to an ART regimen.Results:Provider and practice random effects jointly explained 6.8% of variation in adherence with patient differences accounted for 45.2% of the variation. Patients seen by generalists and other specialists had a 1.6 [95% confidence interval (CI): 0.6–2.5] and 5.1 (95% CI: 4.1–6.1) percentage point greater adherence than those seen by infectious disease specialists (P< 0.001). Every additional year a patient saw the same provider was associated with a 6% increase in adherence (95% CI: 5.7–6.3).Conclusion:There is substantial variation in ART adherence attributable to providers and practices and between provider specialties. To improve ART adherence for patients living with HIV, structural aspects of care should be considered.