What factors are associated with patient self-reported health status among HIV outpatients? A multi-centre UK study of biomedical and psychosocial factors
What factors are associated with patient self-reported health status among HIV outpatients? A multi-centre UK study of biomedical and psychosocial factors
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DOI：
10.1080/09540121.2012.668175
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发表时间：
2012-01-01
影响因子：
1.7
通讯作者：
Sherr, Lorraine
中科院分区：
文献类型：
--
作者：
Harding, Richard;Clucas, Claudine;Sherr, Lorraine
患者自我报告的结果在衡量疾病、治疗和护理结果方面变得越来越重要。目前尚不清楚对于接受抗逆转录病毒治疗（ART）的患者来说，采用生物医学和心理社会相结合的方法所带来的幸福感是什么。本研究旨在利用 EuroQOL-5D 现有的五个维度来确定健康状况视觉模拟量表 (VAS) 测量的差异，确定哪些领域对自我报告的健康状况影响最大，并利用 HIV 门诊患者的生物医学和心理社会因素来确定与 VAS 的关联。英国五家诊所的连续患者被招募参加一项横断面调查，n = 778（响应率为 86%）。患者自行完成验证措施，并从文件中提取治疗变量。在 EuroQOL-5D 中，近三分之一 (28.1%) 的人存在行动问题，五分之一 (18.7%) 的人存在自我护理问题，三分之一 (37.4%) 的人难以执行日常任务，一半 (44.4%) 的人表示有疼痛/不适。在确定与自我报告健康状况（VAS 评分）关联的回归模型中，CD4 计数和 ART 状态均与结果无关。然而，除了 EuroQOL-5D 的四个维度外，较差的健康状况还与较差的身体症状负担、治疗乐观度和心理症状相关。心理发病率和身体机能较差的患病率相对较高，这些疾病负担与自我报告的健康状况较差有关。由于艾滋病毒管理的重点是延长生存期和慢性疾病模型的治疗，因此临床对患者护理的生理和心理层面的关注对于实现最佳健康至关重要。
Patient self-reported outcomes are increasingly important in measuring disease, treatment and care outcomes. It is unclear what constitutes well-being using a combined biomedical and psychosocial approach for patients with antiretroviral therapy (ART) access. This study aimed to determine the variance within the visual analogue scale (VAS) measure of health status using the existing five dimensions of the EuroQOL-5D, to identify which domains have the greatest effect on self-reported health status and to identify associations with the VAS using both biomedical and psychosocial factors among HIV outpatients. Consecutive patients in five UK clinics were recruited to a cross-sectional survey, n = 778 (86% response rate). Patients self-completed validated measures, with treatment variables extracted from file. On the EuroQOL-5D, nearly one-third (28.1%) had mobility problems, one-fifth (18.7%) self-care problems, one-third (37.4%) difficulty in performing usual tasks and one-half (44.4%) reported pain/discomfort. In the regression model to determine associations with self-reported health status (VAS score), neither CD4 count nor ART status was associated with the outcome. However, in addition to four dimensions of the EuroQOL-5D, poorer health status was associated with worse physical symptom burden, treatment optimism and psychological symptoms. There is a relatively high prevalence of psychological morbidity and poor physical function, and these burdens of disease are associated with worse self-reported health status. As HIV management focuses on treatment for extended survival and a chronic model of disease, clinical attention to physical and psychological dimensions of patient care are essential to achieve optimal well-being.