Effect of case management on unmet needs and utilization of medical care and medications among HIV-infected persons
Effect of case management on unmet needs and utilization of medical care and medications among HIV-infected persons
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DOI：
10.7326/0003-4819-135-8_part_1-200110160-00006
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发表时间：
2001-10-16
影响因子：
39.2
通讯作者：
Shapiro, MF
中科院分区：
文献类型：
--
作者：
Katz, MH;Cunningham, WE;Shapiro, MF
背景：尽管病例管理一直被提倡作为一种改善慢性病患者护理的方法，但其有效性尚不清楚。目的：评估病例管理对艾滋病毒感染者未满足的支持性服务需求以及医疗保健和药物利用的影响。设计：对全国概率样本进行基线和随访访谈。环境：美国的住院和门诊医疗机构。参与者：2437名感染艾滋病毒的成年人，代表217 081名接受医疗护理的患者。测量：在随访中测量的结果是未满足的支持性服务需求、医疗保健利用（门诊就诊、急诊就诊和住院）和艾滋病毒药物的使用（接受抗逆转录病毒治疗和预防卡氏肺囊虫肺炎和弓形虫病）。结果：在基线时，56.5%的样本在过去6个月内与病例管理人员有过接触。在对潜在混杂因素进行校正的多重逻辑回归分析中，基线时与病例管理人员的接触与未满足的收入援助需求减少（比值比[OR]， 0.57 [95% Cl， 0.36至0.91]）、健康保险（比值比[OR]， 0.54 [CI， 0.33至0.89]）、家庭保健（OR, 0.29 [Cl， 0.15至0.56]）和情绪咨询（OR, 0.62 [CI， 0.41至0.94]）相关。与病例管理人员的接触与门诊护理（OR, 0.77 [Cl， 0.57至1.04]）、住院（OR, 1.13 [CI， 0.84至1.54]）或急诊科就诊（OR, 1.30 [Cl， 0.97至1.73]）的使用率无显著相关性，但与双药(OR, 1.58 （Cl， 1.23至2.03]）和三药（OR, 1.34 [Cl， 1.00至1.80]）抗逆转录病毒治疗方案以及蛋白酶抑制剂或非核苷类逆转录酶抑制剂（OR, 1.29 [CI, 1.29]）的使用率较高相关。1.02至1.64])。结论：病例管理似乎与接受艾滋病毒治疗的患者较少的未满足需求和较高的艾滋病毒药物使用有关。
Background: Although case management has been advocated as a method for improving the care of chronically ill persons, its effectiveness is poorly understood.Objective: To assess the effect of case managers on unmet need for supportive services and utilization of medical care and medications among HIV-Infected persons.Design: Baseline and follow-up interview of a national probability sample.Setting: Inpatient and outpatient medical facilities in the United States.Participants: 2437 HIV-infected adults representing 217 081 patients receiving medical care.Measurements: Outcomes measured at follow-up were unmet need for supportive services, medical care utilization (ambulatory visits, emergency department visits, and hospitalizations), and use of HIV medication (receipt of antiretroviral therapy and prophylaxis against Pneumocystis carinii pneumonia and toxoplasmosis).Results: At baseline, 56.5% of the sample had contact with a case manager in the previous 6 months. In multiple logistic regression analyses that adjusted for potential confounders, contact with a case manager at baseline was associated with decreased unmet need for income assistance (odds ratio [OR], 0.57 [95% Cl, 0.36 to 0.91]), health insurance (OR, 0.54 [CI, 0.33 to 0.89]), home health care (OR, 0.29 [Cl, 0.15 to 0.56]), and emotional counseling (OR, 0.62 [CI, 0.41 to 0.94]) at follow-up. Contact with case managers was not significantly associated with utilization of ambulatory care (OR, 0.77 [Cl, 0.57 to 1.04]), hospitalization (OR, 1.13 [CI, 0.84 to 1.54]), or emergency department visits (OR, 1.30 [Cl, 0.97 to 1.73]) but was associated with higher utilization of two-drug (OR, 1.58 (Cl, 1.23 to 2.03]) and three-drug (OR, 1.34 [Cl, 1.00 to 1.80]) antiretroviral regimens and of treatment with protease inhibitors or non-nucleoside reverse transcriptase inhibitors (OR, 1.29 [CI, 1.02 to 1.64]) at follow-up.Conclusions: case management appears to be associated with fewer unmet needs and higher use of HIV medications in patients receiving HIV treatment.