HIV-positive injection drug users who leave the hospital against medical advice - The mitigating role of methadone and social support
HIV-positive injection drug users who leave the hospital against medical advice - The mitigating role of methadone and social support
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DOI：
10.1097/00126334-200401010-00008
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发表时间：
2004-01-01
影响因子：
3.6
通讯作者：
Anis, AH
中科院分区：
文献类型：
--
作者：
Chan, ACH;Palepu, A;Anis, AH
背景：违背医嘱离开医院与发病率和再入院率的增加有关。艾滋病毒/艾滋病患者或注射毒品使用者中与不遵医嘱离开的风险有关的因素尚未得到详细研究。目的：在有注射吸毒史的艾滋病患者中，研究与违背医嘱（AMA）离开艾滋病专科病房相关的临床和社会因素。方法：所有在温哥华圣保罗医院艾滋病毒/艾滋病病房住院的有注射吸毒史的患者，不列颠哥伦比亚省（加拿大最大的艾滋病毒/艾滋病专科医院病房）之间的1997年4月和2000年10月进行了回顾性审查。一个多变量Logistic回归模型，利用广义估计方程算法确定的因素与离开医院AMA.Results：在1056医院的艾滋病毒/艾滋病病房的病人注射吸毒史，263（24.9%）导致离开医院AMA。退出AMA的独立阳性预测因子包括近期注射毒品使用（调整后的比值比[AOR] 2.08，95%置信区间[CI]：1.41-3.07）和原住民种族（AOR = 1.55，95% CI：1.05-2.28）。出院AMA也更可能发生在周末（AOR = 2.27，95% CI：1.49-3.48）和发放社会救济金的日子（AOR = 2.95，95% CI：1.70-5.10）。独立降低AMA出院几率的因素包括院内美沙酮的使用（AOR = 0.49，95%CI：0.32-0.76），社会支持（AOR = 0.33，95% CI：0.21-0.51），以及年龄较大（每10年增量，AOR = 0.56，95% CI：0.43-0.73）。在有注射吸毒史的HIV阳性患者中，接受住院美沙酮治疗的受试者离开医院AMA的几率降低，年龄较大，或者有社会支持。应进一步探讨成瘾治疗和干预措施，以加强对有出院风险的边缘化人群的社会支持。
Background: Leaving the hospital against medical advice has been associated with increased morbidity and readmission. Factors associated with the risk of leaving against medical advice among HIV/AIDS patients or injection drug users have not been examined in detail. Objectives: To examine the clinical and social factors associated with leaving against medical advice (AMA) from a specialized HIV/AIDS ward among patients who reported a history of injection drug use.Methods: All patients with a history of injection drug use admitted to the HIV/AIDS ward at St. Paul's Hospital, Vancouver, British Columbia (the largest specialized HIV/AIDS hospital ward in Canada) between April 1997 and October 2000 were reviewed retrospectively. A multivariate logistic regression model utilizing a generalized estimating equation algorithm identified factors associated with leaving the hospital AMA.Results: Of the 1056 hospital admissions to the HIV/AIDS ward by patients with a history of injection drug use, 263 (24.9%) resulted in leaving the hospital AMA. Independent positive predictors of leaving AMA included recent injection drug use (adjusted odds ratio [AOR] 2.08, 95% confidence interval [CI]: 1.41-3.07) and aboriginal ethnicity (AOR = 1.55, 95% CI: 1.05-2.28). Discharge AMA was also more likely to occur on weekends (AOR = 2.27, 95% CI: 1.49-3.48) and on days when social assistance payments were issued (AOR = 2.95, 95% CI: 1.70-5.10). Factors that independently reduced the odds of hospital discharge AMA included in-hospital methadone use (AOR = 0.49, 95% CI: 0.32-0.76), social support (AOR = 0.33, 95% CI: 0.21-0.51), and older age (per 10-year increment, AOR = 0,56, 95% Cl: 0.43-0.73).Conclusions: Among HIV-positive patients with a history of injection drug use, the odds of leaving the hospital AMA were reduced for subjects who received inpatient methadone treatment, were of older age, or had social supports. Addiction treatment and interventions that enhance social supports in marginalized populations at risk for hospital discharge AMA should be further explored.