Impact of Availability of Telehealth Programs on Documented HIV Viral Suppression: A Cluster-Randomized Program Evaluation in the Veterans Health Administration
Impact of Availability of Telehealth Programs on Documented HIV Viral Suppression: A Cluster-Randomized Program Evaluation in the Veterans Health Administration
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DOI：
10.1093/ofid/ofz206
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发表时间：
2019-06-01
影响因子：
4.2
通讯作者：
Vaughan-Sarrazin, Mary
中科院分区：
文献类型：
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作者：
Ohl, Michael E.;Richardson, Kelly;Vaughan-Sarrazin, Mary
背景远程保健可以改善对远离艾滋病毒专科诊所的艾滋病毒感染者的护理。我们进行了一项随机分组评估，以确定艾滋病毒远程医疗计划的可用性对退伍军人管理局诊所记录的病毒抑制的影响。2015-2016年，之前去过艾滋病毒专科诊所的人可以在附近的初级保健诊所获得远程医疗就诊。患者被随机分组为即时远程医疗可用性（n = 925例患者在13个提供远程医疗的初级保健诊所的服务区）或1年后的可用性（n = 745例患者在12个诊所）。评价年度的措施包括在可提供远程保健并记录了艾滋病毒抑制情况（病毒载量< 200拷贝/毫升）的地区的患者中使用远程保健。使用意向治疗（ITT）分析来确定远程医疗可用性的影响，该分析比较了远程医疗可用地区患者的结局与远程医疗不可用地区患者的结局，无论远程医疗使用情况如何。编译器平均因果效应（CACEs）比较结果的远程医疗用户与结果的控制患者具有相同的倾向，使用远程医疗，当可用。总体而言，120名（13.0%）患者在远程医疗可用时使用了远程医疗。在ITT分析中，远程医疗项目的可用性导致病毒抑制的小幅改善（78.3%对74.1%;相对风险[RR]，1.06; 95%置信区间[CI]，1.01至1.11），CACE分析中远程保健用户的大幅改善（91.5%vs 80.0%，RR，1.14; 95%CI，1.01 ~ 1.30）。远程保健方案的可用性改善了记录在案的病毒抑制。艾滋病毒诊所应为面临旅行负担的患者提供远程保健访问。
Background. Telehealth may improve care for people with HIV who live far from HIV specialty clinics. We conducted a cluster-randomized evaluation to determine the impact of availability of HIV telehealth programs on documented viral suppression in Veterans Administration clinics.Methods. In 2015-2016, people who previously traveled to HIV specialty clinics were offered telehealth visits in nearby primary care clinics. Patients were cluster-randomized to immediate telehealth availability (n = 925 patients in service areas of 13 primary care clinics offering telehealth) or availability 1 year later (n = 745 patients in 12 clinics). Measures during the evaluation year included telehealth use among patients in areas where telehealth was available and documented HIV viral suppression (viral load performed and < 200 copies/mL). Impact of telehealth availability was determined using intention-to-treat (ITT) analyses that compared outcomes for patients in areas where telehealth was available with outcomes for patients where telehealth was not available, regardless of telehealth use. Complier average causal effects (CACEs) compared outcomes for telehealth users with outcomes for control patients with equal propensity to use telehealth, when available.Results. Overall, 120 (13.0%) patients utilized telehealth when it was available. Availability of telehealth programs led to small improvements in viral suppression in ITT analyses (78.3% vs 74.1%; relative risk [RR], 1.06; 95% confidence interval [CI], 1.01 to 1.11) and large improvements among telehealth users in CACE analyses (91.5% vs 80.0%; RR, 1.14; 95% CI, 1.01 to 1.30).Conclusions. Availability of telehealth programs improved documented viral suppression. HIV clinics should offer telehealth visits for patients facing travel burdens.