Costs of care for people living with combined HIV/AIDS, chronic mental illness, and substance abuse disorders
Costs of care for people living with combined HIV/AIDS, chronic mental illness, and substance abuse disorders
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DOI：
10.1080/09540120902923006
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发表时间：
2009-01-01
影响因子：
1.7
通讯作者：
Ettner, Susan L.
中科院分区：
文献类型：
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作者：
Conover, Christopher J.;Weaver, Marcia;Ettner, Susan L.
为了确定三重诊断成人的医疗保健可及性和费用，我们检查了来自艾滋病毒/艾滋病治疗依从性、健康结果和成本研究的基线数据，这是一项2000年至2004年间进行的艾滋病毒阳性成人同时发生精神和药物滥用障碍的多地点队列研究。在全国8个主要城市地区对1138名三重诊断的成年人进行了基线访谈。使用修改版的《精神障碍诊断与统计手册》第4版（DSM-IV）对前一年的诊断进行分配。在过去的三个月里，广泛的住院和门诊服务和药物的使用情况是患者在面对面访谈中报告的。然后，我们应用具有全国代表性的单位成本来计算平均每月支出。在三个月期间，我们通过患者是否有：(a)没有门诊就诊来衡量（差）获得护理的机会；(b)至少一次急症室就诊而没有相关住院；(c)至少一次住院治疗。在基线时，每位患者每月的平均支出为3880美元。这几乎是一般艾滋病毒/艾滋病患者支出的两倍。住院治疗（36%）、药物治疗（33%）和门诊服务（31%）各占大约三分之一的支出。在不同亚组的患者中，医疗保险或医疗补助、居住不稳定、身体健康状况不佳或病毒载量高的患者的费用最高，其差异为2:1。女性和低收入、住所不稳定、同性接触、身体或精神健康状况不佳以及病毒载量高的人获得医疗服务的机会更差。我们的结论是，艾滋病毒三次诊断的成年人约占艾滋病毒患者医疗支出的五分之一，并且不同患者亚组的使用率/成本差异很大。对于许多三重诊断的患者来说，实现的可及性是好的，但总体而言仍不理想。艾滋病毒护理方面的缺陷分布不均，往往集中在已经处于不利地位的人群。
To determine healthcare access and costs for triply diagnosed adults, we examined baseline data from the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study, a multi-site cohort study of HIV + adults with co-occurring mental and substance abuse disorders conducted between 2000 and 2004. Baseline interviews were conducted with 1138 triply diagnosed adults in eight predominantly urban sites nationwide. A modified version of Structured Interview for DSM-IV Axis I Disorders (SCID) was used to assign Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses for the preceding year. Utilization of a broad range of inpatient and outpatient services and medications over the preceding three months was patient-reported in face-to-face interviews. We then applied nationally representative unit costs to impute average monthly expenditures. We measured (poor) access to care during the three-month period by whether the patient had: (a) no outpatient medical visits; (b) at least one emergency room visit without an associated hospitalization; and (c) at least one hospitalization. At baseline, mean expenditures were $3880 per patient per month. This is nearly twice as high as expenditures for HIV/AIDS patients in general. Inpatient care (36%), medications (33%), and outpatient services (31%) each accounted for roughly one-third of expenditures. Expenditures varied by a factor of 2:1 among subgroups of patients, with those on Medicare or Medicaid, not in stable residences, or with poor physical health or high viral loads exhibiting the highest costs. Access to care was worse for women and those with low incomes, unstable residences, same-sex exposure, poor physical or mental health, and high viral loads. We conclude that HIV triply diagnosed adults account for roughly one-fifth of medical spending on HIV patients and that there are large variations in utilization/costs across patient subgroups. Realized access is good for many triply diagnosed patients, but remains suboptimal overall. Deficiencies in HIV care are unevenly distributed, tending to concentrate on already disadvantaged populations.