The influence of healthcare financing on cardiovascular disease prevention in people living with HIV.
The influence of healthcare financing on cardiovascular disease prevention in people living with HIV.
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DOI：
10.1186/s12889-020-09896-8
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发表时间：
2020-11-23
影响因子：
4.5
通讯作者：
Longenecker CT
中科院分区：
文献类型：
--
作者：
Webel AR;Schexnayder J;Rentrope CR;Bosworth HB;Hileman CO;Okeke NL;Vedanthan R;Longenecker CT
艾滋病毒感染者被诊断出患有与年龄相关的慢性健康状况（包括心血管疾病）的比率高于预期。这些慢性健康状况的医疗管理经常由受过普通内科、家庭医学或传染病培训的提供者在艾滋病毒专科诊所进行。近年来，由于平价医疗法案的变化，美国艾滋病毒感染者的医疗融资发生了动态变化。几乎没有证据表明医疗保健融资特征如何影响艾滋病毒感染者的一级和二级心血管疾病预防。我们的目标是研究艾滋病毒感染者及其医疗保健提供者对医疗保健融资如何影响心血管疾病预防的看法。作为 EXTRA-CVD 研究的一部分，我们于 2018 年 10 月至 2019 年 3 月对俄亥俄州和北卡罗来纳州的三个美国 HIV 诊所的 51 名 HIV 感染者和 34 名多学科医疗保健提供者进行了深入的半结构化访谈。使用模板分析技术进行主题分析，以检查 HIV 感染者的医疗融资障碍和心血管疾病预防的推动因素。跨场所和学科出现了三个主题 (1)：医疗保健支付者在很大程度上影响了艾滋病毒诊所的预防性心血管护理 (2)；与相对价值单位挂钩的医生薪酬会抑制艾滋病毒提供者预防心血管疾病的努力； (3) 基于赠款的服务可以实现量身定制的心血管疾病预防，但可持续性受到资助者优先事项的限制。由于艾滋病毒现已成为一种慢性疾病，因此对艾滋病毒特异性心血管疾病预防的需求日益增长；然而，医疗保健融资使这种预防性护理的有效提供变得复杂。了解不断发展的付款人模式对患者和医疗保健提供者行为的影响非常重要。对这些模型的进一步系统研究将帮助艾滋病毒专科诊所在动态报销范围内实施心血管疾病预防。临床试验注册号：NCT03643705。
People living with HIV are diagnosed with age-related chronic health conditions, including cardiovascular disease, at higher than expected rates. Medical management of these chronic health conditions frequently occur in HIV specialty clinics by providers trained in general internal medicine, family medicine, or infectious disease. In recent years, changes in the healthcare financing for people living with HIV in the U.S. has been dynamic due to changes in the Affordable Care Act. There is little evidence examining how healthcare financing characteristics shape primary and secondary cardiovascular disease prevention among people living with HIV. Our objective was to examine the perspectives of people living with HIV and their healthcare providers on how healthcare financing influences cardiovascular disease prevention. As part of the EXTRA-CVD study, we conducted in-depth, semi-structured interviews with 51 people living with HIV and 34 multidisciplinary healthcare providers and at three U.S. HIV clinics in Ohio and North Carolina from October 2018 to March 2019. Thematic analysis using Template Analysis techniques was used to examine healthcare financing barriers and enablers of cardiovascular disease prevention in people living with HIV. Three themes emerged across sites and disciplines (1): healthcare payers substantially shape preventative cardiovascular care in HIV clinics (2); physician compensation tied to relative value units disincentivizes cardiovascular disease prevention efforts by HIV providers; and (3) grant-based services enable tailored cardiovascular disease prevention, but sustainability is limited by sponsor priorities. With HIV now a chronic disease, there is a growing need for HIV-specific cardiovascular disease prevention; however, healthcare financing complicates effective delivery of this preventative care. It is important to understand the effects of evolving payer models on patient and healthcare provider behavior. Additional systematic investigation of these models will help HIV specialty clinics implement cardiovascular disease prevention within a dynamic reimbursement landscape. Clinical Trial Registration Number: NCT03643705.
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DOI：
10.1186/s13012-017-0605-9
发表时间：
2017-06-21
期刊：
Implementation science : IS
影响因子：
--
作者：
Atkins L;Francis J;Islam R;O'Connor D;Patey A;Ivers N;Foy R;Duncan EM;Colquhoun H;Grimshaw JM;Lawton R;Michie S
通讯作者：
Michie S
影响因子：
5.7
作者：
Linzer, Mark;Poplau, Sara;Ovington, Kay
通讯作者：
Ovington, Kay
影响因子：
37.8
作者：
Feinstein MJ;Hsue PY;Benjamin LA;Bloomfield GS;Currier JS;Freiberg MS;Grinspoon SK;Levin J;Longenecker CT;Post WS
通讯作者：
Post WS
影响因子：
1.7
作者：
Guest, Greg;Bunce, Arwen;Johnson, Laura
通讯作者：
Johnson, Laura
影响因子：
6.6
作者：
Burd, Carlye;Gruss, Stephanie;Alley, Dawn
通讯作者：
Alley, Dawn