Healthcare utilization of patients accessing an African national treatment program
Healthcare utilization of patients accessing an African national treatment program
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DOI：
10.1186/1472-6963-7-80
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发表时间：
2007-06-07
影响因子：
2.8
通讯作者：
Wood, Robin
中科院分区：
文献类型：
--
作者：
Harling, Guy;Orrell, Catherine;Wood, Robin
背景：在非洲推广抗逆转录病毒疗法（ART）将产生重大的资源影响，因为它对保健服务需求产生影响。目前已在发达国家开展了针对高效抗逆转录病毒疗法的医疗保健利用情况的研究，在这些国家，高效抗逆转录病毒疗法是在艾滋病毒病情较轻时开始的。方法：本文描述了南非近郊定居点中未接受治疗的患者从项目进入的医疗保健利用情况。治疗标准包括CD4细胞计数< 200细胞/ μ l或艾滋病定义疾病。从初级保健诊所和二级和三级转诊医院回顾性收集卫生服务利用数据。对每次医院访问进行审查，以确定每次访问的临床原因。结果：212例患者随访时间中位数为490天。每100患者年观察（PYO）的门诊次数（不包括预定的初级保健随访）从抗逆转录病毒治疗前的596次下降到治疗前48周的334次和治疗后的245次。总住院时间从抗逆转录病毒治疗前的每100 PYO 2549天下降到治疗前48周的476天，之后的73天。医疗保健利用的下降发生在各级护理中。使用司他夫定的最大原因是结核病、隐球菌性脑膜炎、hiv相关肿瘤和对司他夫定的不良反应。抗逆转录病毒治疗48周后，需求恢复到主要与艾滋病毒无关的原因。结论：在公共部门开始抗逆转录病毒治疗后，南非病人住院和门诊医院服务的使用率显著下降，住院需求下降最快。早期开始治疗可能会降低早期抗逆转录病毒治疗的使用率。
Background: The roll-out of antiretroviral therapy (ART) in Africa will have significant resource implications arising from its impact on demand for healthcare services. Existing studies of healthcare utilization on HAART have been conducted in the developed world, where HAART is commenced when HIV illness is less advanced.Methods: This paper describes healthcare utilization from program entry by treatment-nave patients in a peri-urban settlement in South Africa. Treatment criteria included a CD4 cell count < 200 cells/mu l or an AIDS-defining illness. Data on health service utilization were collected retrospectively from the primary-care clinic and secondary and tertiary referral hospitals. Hospital visits were reviewed to determine the clinical reason for each visit.Results: 212 patients were followed for a median of 490 days. Outpatient visits per 100 patient years of observation (PYO), excluding scheduled primary-care follow-up, fell from 596 immediately prior to ART to 334 in the first 48 weeks on therapy and 245 thereafter. Total inpatient time fell from 2,549 days per 100 PYO pre-ART to 476 in the first 48 weeks on therapy and 73 thereafter. This fall in healthcare utilization occurred at every level of care. The greatest causes of utilization were tuberculosis, cryptococcal meningitis, HIV-related neoplasms and adverse reactions to stavudine. After 48 weeks on ART demand reverted to primarily non-HIV-related causes.Conclusion: Utilization of both inpatient and outpatient hospital services fell significantly after commencement of ART for South African patients in the public sector, with inpatient demand falling fastest. Earlier initiation might reduce early on-ART utilization rates.