Virtual support for paediatric HIV treatment decision making
Virtual support for paediatric HIV treatment decision making
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DOI：
10.1136/archdischild-2014-307019
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发表时间：
2015-06-01
影响因子：
5.2
通讯作者：
Foster, C.
中科院分区：
文献类型：
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作者：
Le Doare, Kirsty;Mackie, N. E.;Foster, C.
目的探讨多学科儿科虚拟诊所(PVC)对儿童HIV复杂病例管理的临床效果。设计：对2009年10月至2013年11月在伦敦帝国理工学院NHS托拉斯圣玛丽医院转诊的0~21岁儿童和青少年(0~21岁)的临床结果进行回顾性分析。结果共转诊37个中心182名儿童234例，讨论42次会议(中位数13岁，智商10~15岁)。转诊的原因包括病毒学失败(44%)、当前方案简化(24%)和抗逆转录病毒药物并发症(24%)。在最近的一次随访中，80%的转介患者提出了PVC建议。病毒学失败后的抑制在第一次转诊后达到48%，在随后的讨论后达到57%，并在95%转诊为简化方案的儿童中保持。根据建议，42%的生化肝炎患者血脂异常得到缓解，73%的患者肝功能恢复正常。坚持支持帮助解决了9名儿童的病毒血症，12%的转诊导致了额外的支持，包括心理、社会服务和心理健康投入。结论多学科虚拟投入与成人在耐药性和新药物方面的专业知识、儿科药物吞咽知识、儿童配方/体重捆绑和父母支持相结合，有助于儿童HIV感染的复杂治疗决策。虚拟诊所模式可以应用于临床网络中其他罕见的儿童复杂疾病的管理。
Objective The objective of this study is to review clinical outcomes of recommendations made by a multidisciplinary paediatric virtual clinic (PVC) for complex case management of paediatric HIV as a model of care within a tertiary network.Design A retrospective review of the clinical outcomes of paediatric and adolescent (0-21 years) referrals to the PVC at St. Mary's Hospital, Imperial College Healthcare NHS Trust, London was performed between October 2009 and November 2013.Results 234 referrals were made for 182 children from 37 centres, discussed in 42 meetings (median age 13 years, IQR 10-15 years). Reasons for referral included virological failure (44%), simplification of the current regimen (24%) and antiretroviral drug complications (24%). At latest follow-up, PVC advice had been instituted in 80% of referrals. Suppression following virological failure was achieved in 48% following first referral and 57% following subsequent discussions and was maintained in 95% of children referred for regimen simplification. Following advice, dyslipidaemia resolved in 42% and liver function normalised in 73% with biochemical hepatitis. Adherence support aided resolution of viraemia in nine children and 12% of referrals resulted in additional support, including psychology, social services and mental health input.Conclusions Combined multidisciplinary virtual input with adult expertise in resistance and newer agents, paediatric knowledge of pill swallowing, childhood formulations/weight banding and parental support, assists complex treatment decision making in paediatric HIV infection. The Virtual Clinic model could be applied to the management of other rare complex diseases of childhood within a clinical network.