Combination antiretroviral therapy: health care providers confront emerging dilemmas.
Combination antiretroviral therapy: health care providers confront emerging dilemmas.
复制标题
联合抗逆转录病毒疗法：医疗保健提供者面临着新出现的困境。
DOI：
10.1080/09540120050123819
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发表时间：
2000
期刊：
影响因子：
1.7
通讯作者：
Bangsberg,D
中科院分区：
文献类型：
--
作者：
Gerbert,B;Bronstone,A;Clanon,K;Abercrombie,P;Bangsberg,D
最近的社论、会议和临床实践文章讨论了提供者对艾滋病毒抗逆转录病毒联合疗法处方的关切和做法。我们的目的是加深我们对这些主要是轶事的报告，并面临的挑战，有经验的艾滋病毒临床医生今天使用定性方法的理解。使用结构化讨论指南，进行了八个重点小组的讨论。数据采用开放码和常数比较分析法进行分析。参与者是一个多元化的23名医生，8名执业护士和4名医生助理，在不同的旧金山弗朗西斯科卫生保健机构提供护理的艾滋病毒血清阳性患者的显着经验。从这些数据中可以看出以下主要主题：（1）提供者对帮助艾滋病毒血清反应阳性患者生活表示了新的乐观态度;（2）影响提供者决定何时开始联合治疗的主要因素是延迟治疗的风险与收益，以及患者的健康状况、坚持治疗的意愿和治疗偏好;（3）提供者缺乏资源来准备患者开始治疗和提高依从性;（4）提供者对依从性的评估各不相同;和（5）提供者对在不确定条件下做出决定感到焦虑，并关注患者的健康结果。我们的结论是，经验丰富的艾滋病毒临床医生对他们帮助患者的能力不断提高充满希望和兴奋。然而，这种希望被对未来的怀疑和他们每天在非常不确定的条件下做出治疗决定的斗争所冲淡。如果没有辅助支持或多学科团队，提供者可能无法最佳地评估和提高抗逆转录病毒药物的依从性。
Recent editorials, conferences and clinical practice articles have discussed providers' concerns and practices regarding prescribing antiretroviral combination therapy for HIV. We aimed to deepen our understanding of these largely anecdotal reports and of the challenges facing experienced HIV clinicians today using qualitative methodology. Eight focus groups using a structured discussion guide were conducted. Data were analyzed by constant comparative analysis and open codes. Participants were a diverse group of 23 physicians, eight nurse practitioners and four physician assistants with significant experience providing care to HIV-seropositive patients in various San Francisco Bay Area health care settings. The following major themes emerged from the data: (1) providers expressed new optimism about helping HIV-seropositive patients live; (2) the main factors affecting providers' decisions about when to start combination therapy were the risks versus benefits of delaying therapy, and patients' health status, readiness to adhere and treatment preferences; (3) providers lacked resources to prepare patients to begin therapy and enhance adherence; (4) providers varied regarding assessment of adherence; and (5) providers were anxious about making decisions under conditions of uncertainty and were concerned about patient health outcomes. We concluded that experienced HIV clinicians were hopeful and excited about their increasing ability to help patients. This hope, however, was tempered by scepticism about the future and by their daily struggles to make treatment decisions under conditions of great uncertainty. Without access to adjunct supports or a multidisciplinary team, providers may not be able to optimally assess and enhance antiretroviral medication adherence.