The Effect of Patient Navigation on the Likelihood of Engagement in Clinical Care for HIV-Infected Individuals Leaving Jail
The Effect of Patient Navigation on the Likelihood of Engagement in Clinical Care for HIV-Infected Individuals Leaving Jail
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DOI：
10.2105/ajph.2017.304250
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发表时间：
2018-03-01
影响因子：
12.7
通讯作者：
Tulsky, Jacqueline
中科院分区：
文献类型：
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作者：
Myers, Janet J.;Dufour, Mi-Suk Kang;Tulsky, Jacqueline
目标.比较患者导航增强的病例管理在支持从监狱释放后从事HIV护理方面与现有服务的有效性。我们将270名艾滋病毒感染者随机分配，在2010年至2013年期间从监狱释放后接受12个月的导航增强型病例管理或90天的标准病例管理。参与者在释放后2个月、6个月和12个月接受采访。我们从监狱和城市健康记录中提取了医疗数据。患者导航增强型病例管理在出院后30天内与护理的联系更大（比值比[OR] = 2.15; 95%置信区间[CI] = 1.23，3.75），并在12个月内保持一致（OR = 1.95; 95% CI = 1.11，3.46）。在监狱中接受物质使用障碍治疗也导致早期联系（OR = 4.06; 95%CI = 1.93，8.53）和保留（OR = 2.52; 95%CI = 1.21，5.23）。拉美裔人不太可能与HIV护理相关（OR = 0.35; 95%CI = 0.14，0.91）或保留在HIV护理中（OR = 0.28; 95%CI = 0.09，0.82）。病人导航支持保持护理参与，可以减轻健康差距，并应成为艾滋病毒感染者离开监狱的护理标准。
Objectives. To compare the effectiveness of patient navigation-enhanced case management in supporting engagement in HIV care upon release from jail relative to existing services.Methods. We randomized 270 HIV-infected individuals to receive navigation-enhanced case management for 12 months or standard case management for 90 days following release from jail between 2010 and 2013. Participants were interviewed at 2, 6, and 12 months after release. We abstracted medical data from jail and city health records.Results. Patient navigation-enhanced case management resulted in greater linkage to care within 30 days of release (odds ratio [OR] = 2.15; 95% confidence interval [CI] = 1.23, 3.75) and consistent retention over 12 months (OR = 1.95; 95% CI = 1.11, 3.46). Receipt of treatment for substance use disorders in jail also resulted in early linkage (OR = 4.06; 95% CI = 1.93, 8.53) and retention (OR = 2.52; 95% CI = 1.21, 5.23). Latinos were less likely to be linked to (OR = 0.35; 95% CI = 0.14, 0.91) or retained in (OR = 0.28; 95% CI = 0.09, 0.82) HIV care.Conclusions. Patient navigation supports maintaining engagement in care and can mitigate health disparities, and should become the standard of care for HIV-infected individuals leaving jail.