Access to HAART and utilization of inpatient medical hospital services among HIV-infected patients with co-occurring serious mental illness and injection drug use
Access to HAART and utilization of inpatient medical hospital services among HIV-infected patients with co-occurring serious mental illness and injection drug use
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DOI：
10.1016/j.genhosppsych.2007.03.008
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发表时间：
2007-11-01
影响因子：
7
通讯作者：
Gebo, Kelly A.
中科院分区：
文献类型：
--
作者：
Himelhoch, Seth;Chander, Geetanjali;Gebo, Kelly A.
目的：在艾滋病毒感染者中，我们研究了是否有并发严重精神疾病（SMI）和注射毒品使用（IDU）的影响：（a）接受高效抗逆转录病毒治疗（HAART），和（B）利用住院艾滋病毒服务，与那些只有SMI，只有IDU或既没有SMI也没有IDU的人相比。人口统计学，临床和资源利用数据收集的5119例患者在艾滋病毒初级保健的医疗记录，在不同的地理区域，在2001年的现场精神卫生服务的四个美国艾滋病毒护理网站。我们用多变量logistic回归分析HAART的接受情况，用多变量logistic和Poisson回归分析住院次数，控制人口学因素，HAART的接受情况，CD 4计数和HIV-1 RNA。95%置信区间（95% CI）=0.41-0.81]和单独使用IDU的患者（AOR=0.64;，95% CI=0.58-0.85）接受HAART的可能性显著低于既不使用SMI也不使用IDU的患者，控制人口统计学和临床因素。同时患有重度精神病和静脉吸毒者更可能使用任何住院医疗服务（AOR=2.22; 95%CI =1.64-3.01），并且更可能更频繁地使用它们（发病率比=1.33，95%CI =1.13-1.55）高于无SMI、无IDU、仅SMI或仅IDU者。与没有合并症或只有一种合并症的个体相比，合并SMI和IDU的HIV感染者更有可能利用HIV相关的医疗住院服务。在接受HAART治疗方面，SMI和IDU患者与IDU患者没有差异。住院治疗费用昂贵，应针对这些人群作出努力，以减少可能避免的住院治疗。(c)2007年爱思唯尔公司All rights reserved.
Objective: Among HIV-infected individuals, we examined whether having co-occurring serious mental illness (SMI) and injection drug use (IDU) impacts: (a) receipt of highly active antiretroviral therapy (HAART), and (b) utilization of inpatient HIV services, compared to those who have SMI only, IDU only or neither SMI nor IDU.Method: Demographic, clinical and resource utilization data were collected from medical records of 5119 patients in HIV primary care at four US HIV care sites in different geographic regions with on-site mental health services in 2001. We analyzed receipt of HAART using multivariate logistic regression and the number of medical hospital admissions using multivariate logistic and Poisson regression analyses, which controlled for demographic factors, receipt of HAART, CD4 count and HIV-1 RNA.Results: Those with co-occurring SMI and IDU [adjusted odds ratio (AOR)=0.52; 95% confidence interval (95% CI)=0.41-0.81] and those with IDU alone (AOR=0.64;, 95% CI=0.58-0.85) were significantly less likely to receive HAART than those with neither SMI nor IDU, controlling for demographic and clinical factors. Those with co-occurring SMI and IDU were more likely to use any inpatient medical services (AOR=2.22; 95% CI=1.64-3.01) and were significantly more likely to use them more frequently (incidence rate ratio=1.33; 95% CI=1.13-1.55) than those with neither SMI nor IDU, SMI only or IDU only.Conclusion: HIV-infected individuals with co-occurring SMI and IDU are significantly more likely to utilize HIV-related medical inpatient services than individuals with no comorbidity or with only one comorbidity. Individuals with both SMI and IDU did not differ from those with IDU only in receipt of HAART. Inpatient hospitalizations are expensive, and efforts should be targeted towards these populations to reduce potentially avoidable inpatient care. (c) 2007 Elsevier Inc. All rights reserved.