Physicians' patient base composition and mortality among people living with HIV who initiated antiretroviral therapy in a universal care setting.
Physicians' patient base composition and mortality among people living with HIV who initiated antiretroviral therapy in a universal care setting.
复制标题
在全民护理环境中开始抗逆转录病毒治疗的艾滋病毒感染者中医生的患者基础构成和死亡率。
DOI：
10.1136/bmjopen-2018-023957
复制
发表时间：
2019
期刊：
影响因子：
2.9
通讯作者：
Hogg,RobertS
中科院分区：
文献类型：
--
作者：
Allan,Beverly;Closson,Kalysha;Collins,AlexandraB;Kibel,Mia;Pan,Shenyi;Cui,Zishan;McLinden,Taylor;Parashar,Surita;Lima,VivianeDias;Chia,Jason;Yip,Benita;Barrios,Rolando;Montaner,JulioSG;Hogg,RobertS
在加拿大不列颠哥伦比亚省（BC），评估医生的患者基础构成对启动高效抗逆转录病毒治疗（HAART）的HIV感染者（PLHIV）全因死亡率的影响。DesignObservational cohort study from 1 January 2000 to 31 December 2013. SettingBC Centre for Excellence in HIV/AIDS'（BC-CfE）Drug Treatment Program，在HAART观察性医学评价和研究（HOMER）研究中，年龄≥ 19岁的艾滋病毒感染者在不列颠哥伦比亚省开始HAART治疗。结果测量通过每月与不列颠哥伦比亚省生命统计局的联系确定的全因死亡率。统计分析我们检查了患者特征之间的关系，医生的病人基础组成，实践的位置，和医生的经验与PLHIV和所有原因的死亡率使用未调整和调整考克斯比例风险models.ResultsA共4 445 PLHIV（中位数年龄= 42，Q1，Q3 = 34-49; 80%男性）有资格参加我们的研究。患者由683名处方医生就诊，在过去2年中，中位经验为77名既往接受过治疗的PLHIV患者（Q1，Q3 = 23-170）。多变量考克斯模型表明，以下因素与全因死亡率相关：（aHR = 1.05/1年增加，95% CI = 1.04 - 1.06），HAART启动年份（2004-2007年：aHR = 0.65，95% CI = 0.53至0.81，2008-2011年：aHR = 0.46，95% CI = 0.35至0.61，参考：2000-2003年），基线时的CD 4细胞计数（aHR = 0.88/100单位细胞/mm 3的增加，95%CI = 0.82至0.94），并且在HAART的第一年中粘附< 95%（aHR = 2.28，95%CI = 1.88至2.76）。此外，医生的患者基础构成，具体而言，有注射吸毒史的患者比例（患者比例每增加10%，aHR = 1.11，95% CI = 1.07 - 1.15）或土著血统（aHR = 1.07/10%增加，95% CI = 1.03-1.11），并且是主要为温哥华海岸卫生局区域以外的个人提供服务的医生的患者（aHR = 1.22，95%CI = 1.01至1.47）与mortality.ConclusionsOur研究结果表明，医生与较高比例的个人谁面临潜在的障碍，以照顾可能需要额外的支持，以减少他们的病人死亡率。未来的研究需要在其他环境中检查这些关系，并确定可能减轻医生患者基础组成与生存率之间关联的策略。
ObjectivesTo assess the impact of physicians’ patient base composition on all-cause mortality among people living with HIV (PLHIV) who initiated highly active antiretroviral therapy (HAART) in British Columbia (BC), Canada.DesignObservational cohort study from 1 January 2000 to 31 December 2013.SettingBC Centre for Excellence in HIV/AIDS’ (BC-CfE) Drug Treatment Program, where HAART is available at no cost.ParticipantsPLHIV aged ≥ 19 who initiated HAART in BC in the HAART Observational Medical Evaluation and Research (HOMER) Study.Outcome measuresAll-cause mortality as determined through monthly linkages to the BC Vital Statistics Agency.Statistical analysisWe examined the relationships between patient characteristics, physicians’ patient base composition, the location of the practice, and physicians’ experience with PLHIV and all-cause mortality using unadjusted and adjusted Cox proportional hazards models.ResultsA total of 4 445 PLHIV (median age = 42, Q1, Q3 = 34–49; 80% male) were eligible for our study. Patients were seen by 683 prescribing physicians with a median experience of 77 previously treated PLHIV in the past 2 years (Q1, Q3 = 23–170). A multivariable Cox model indicated that the following factors were associated with all-cause mortality: age (aHR = 1.05 per 1-year increase, 95% CI = 1.04 to 1.06), year of HAART initiation (2004–2007: aHR = 0.65, 95% CI = 0.53 to 0.81, 2008-2011: aHR = 0.46, 95% CI = 0.35 to 0.61, Ref: 2000–2003), CD4 cell count at baseline (aHR = 0.88 per 100-unit increase in cells/mm3, 95% CI = 0.82 to 0.94), and < 95% adherence in first year on HAART (aHR = 2.28, 95% CI = 1.88 to 2.76). In addition, physicians’ patient base composition, specifically, the proportion of patients who have a history of injection drug use (aHR = 1.11 per 10% increase in the proportion of patients, 95% CI = 1.07 to 1.15) or Indigenous ancestry (aHR = 1.07 per 10% increase , 95% CI = 1.03–1.11) and being a patient of a physician who primarily serves individuals outside of the Vancouver Coastal Health Authority region (aHR = 1.22, 95% CI = 1.01 to 1.47) were associated with mortality.ConclusionsOur findings suggest that physicians with a higher proportion of individuals who face potential barriers to care may need additional supports to decrease mortality among their patients. Future research is required to examine these relationships in other settings and to determine strategies that may mitigate the associations between the composition of physicians’ patient bases and survival.