Modelling clinical progression and health care utilization of HIV-positive patients in British Columbia prior to death.
Modelling clinical progression and health care utilization of HIV-positive patients in British Columbia prior to death.
复制标题
对不列颠哥伦比亚省艾滋病毒阳性患者死亡前的临床进展和医疗保健利用进行建模。
作者：
Cui,Z;Grafstein,E;Yip,B;Hogg,R;Montaner,JSG;Lima,VD
目的 HIV 阳性患者的临床进展在多大程度上导致医疗保健利用率增加，特别是在他们死亡之前，尚不清楚。因此，我们对 CD4 细胞计数和急诊室利用率的趋势以及患者因非意外原因死亡之前因急诊科就诊导致转入急症护理级别机构的可能性进行了建模。 方法 1996 年 8 月至 2006 年 6 月期间，符合条件的患者在不列颠哥伦比亚省开始高效抗逆转录病毒治疗 (HAART) (n= 457)。对患者进行随访直至死亡，死亡发生在 2007 年 6 月 30 日或之前（急诊科就诊数据可用的时期）。使用广义混合效应对趋势进行建模。结果在死亡前 5 年内，患者的 CD4 细胞计数显着急剧下降，急诊科就诊和转移至急性级别设施的次数相应增加。死亡前每间隔 6 个月，CD4 细胞计数就会减少 13.22 个细胞/μL，急诊科就诊的风险就会增加 9%，而在曾经入院的患者中，被转移到急症护理机构的几率会增加 3%。结论我们发现，患者的 CD4 细胞计数急剧下降，这与死前医疗保健利用率的增加有关。这些发现凸显了即使在高效抗逆转录病毒治疗（HAART）时代，未成功控制艾滋病毒疾病也会造成大量可避免的残余负担。迫切需要采取进一步的战略来加强持续和成功的护理参与，以缓解医疗保健的高利用率。
ObjectivesThe extent to which clinical progression of HIV‐positive patients leads to an increase in health care utilization, especially prior to their death, is unknown. Thus, we modelled trends in CD4 cell count and emergency department utilization and the likelihood of an emergency department visit leading to a transfer to an acute care‐level facility prior to a patient's death from nonaccidental causes.MethodsEligible patients initiated highly active antiretroviral therapy (HAART) in British Columbia between August 1996 and June 2006 (n= 457). Patients were followed until their death, which occurred on or before 30 June 2007 (period in which the emergency department visit data were available). Trends were modelled using generalized mixed effects.ResultsPatients experienced a significantly steep decline in CD4 cell count and a corresponding increase in the number of emergency department visits and transfers to acute‐level facilities in the 5 years prior to death. For every 6‐month interval prior to death, the CD4 cell count decreased by 13.22 cells/μL, the risk of experiencing an emergency department visit increased by 9%, and among those ever admitted, the odds ratio of being transferred to an acute care‐level facility increased by 3%.ConclusionsWe showed that patients experienced a steep decline in CD4 cell count, which was associated with an increase in health care utilization prior to their death. These findings highlight the substantial residual avoidable burden that unsuccessfully managed HIV disease poses, even in the HAART era. Further strategies to enhance sustained and successful engagement in care are urgently needed to mitigate high health care utilization.