Is travel-time to a specialist centre a risk factor for non-referral, non-attendance and loss to follow-up among patients with hepatitis C (HCV) infection?
Is travel-time to a specialist centre a risk factor for non-referral, non-attendance and loss to follow-up among patients with hepatitis C (HCV) infection?
复制标题
前往专科中心的时间是否是丙型肝炎 (HCV) 感染患者不转诊、不就诊和失访的危险因素？
DOI：
10.1016/j.socscimed.2012.02.046
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发表时间：
2012-07-01
影响因子：
5.4
通讯作者：
Dillon, John
中科院分区：
文献类型：
--
作者：
Astell-Burt, Thomas;Flowerdew, Robin;Dillon, John
很少有人知道为什么许多被诊断患有丙型肝炎病毒（HCV）感染的人无法到达并留在专科护理服务中。我们使用了地理信息系统和logit回归，以调查是否旅行时间的专家中心与增加的可能性，非转诊，非出勤率和损失的后续诊断与丙型肝炎病毒在1991年和2003年之间在苏格兰泰赛德（英国）。在1991年至2006年期间，泰赛德的单一HCV专科中心的转诊和利用信息是可用的。到专科中心的旅行时间较长与诊断后不转诊到专科中心的可能性增加相关（比值比：1.25，95%置信区间：1.09，1.44）。居住在远离HCV专科中心的患者不太可能被转诊到该中心接受可以治愈其HCV感染的治疗。无论是静脉吸毒史（IDU），也没有区域剥夺预测非转诊。转诊后，前往专科中心的旅行时间与未就诊（0.83（0.56，1.21））或失访（0.98（0.78，1.22））无关，尽管IDU病史是未就诊和失访的强预测因素。老年患者中不太可能出现失访，而生活在贫困地区的患者中失访更为常见。一旦转诊，患者似乎能够科普长期频繁前往医院的压力和经济成本。然而，随着转介率的提高，从地理上更偏远的地区，长途旅行到丙型肝炎病毒专家中心可能成为一个重要因素，决定未来的利用率。(C)2012爱思唯尔有限公司保留所有权利。
Little is known about why many people diagnosed with hepatitis C virus (HCV) infection fail to reach and stay within specialist care services. We used a Geographic Information System and logit regression to investigate whether travel-time to a specialist centre was associated with an increased likelihood of non-referral, non-attendance and loss to follow-up among persons diagnosed with HCV between 1991 and 2003 in Tayside, Scotland (UK). Information was available on referral to, and utilisation of, the single HCV specialist centre in Tayside between 1991 and 2006.Longer travel-time to a specialist centre was associated with an increased likelihood of non-referral to a specialist centre following diagnosis (Odds Ratio: 1.25, 95% Confidence Interval: 1.09, 1.44). Patients living further from an HCV specialist centre were less likely to be referred to it for treatment that could cure their HCV infection. Neither a history of intravenous drug use (IDU), nor area deprivation predicted non-referral. Subsequent to referral, travel-time to a specialist centre was not associated with either non-attendance (0.83 (0.56, 1.21)) or loss to follow-up (0.98 (0.78, 1.22)), although a history of IDU was a strong predictor of both non-attendance and loss to follow-up. Non-attendance was less likely among older patients, while loss to follow-up was more common among those living in deprived areas.Once referred, patients appear able to cope with stress and financial cost of long and frequent journeys to hospital. However, as rates of referral improve from more geographically remote areas, long travel-times to an HCV specialist centre may become an important factor determining future utilisation. (C) 2012 Elsevier Ltd. All rights reserved.