Utilization of health care services in hard-to-reach marginalized HIV-infected individuals
Utilization of health care services in hard-to-reach marginalized HIV-infected individuals
复制标题
DOI：
10.1089/apc.2006.103
复制
发表时间：
2007-03-01
影响因子：
4.9
通讯作者：
Cabral, Howard D.
中科院分区：
文献类型：
--
作者：
Cunningham, Chinazo O.;Sohler, Nancy L.;Cabral, Howard D.
为了受益于艾滋病毒治疗的进步，个人必须利用流动初级保健服务。很少有研究关注边缘化人群，他们往往有不良的卫生保健利用模式。本研究探讨了与难以接触的边缘化艾滋病毒感染者的卫生保健利用相关的因素。作为评估针对服务不足的艾滋病毒感染者的外展计划的一部分，610名参与者接受了关于他们的艾滋病毒疾病，卫生服务利用，物质使用，心理健康和病例管理的采访。主要结局包括门诊、急诊和住院访视。Logistic回归分析采用广义估计方程。回归分析显示，门诊就诊与有保险（调整后的比值比[AOR] = 2.46）、心理健康药物（AOR = 7.46）和病例管理（AOR = 4.81）相关。急诊就诊与有保险（AOR = 1.74），无家可归（AOR = 2.23），健康状况不佳（AOR = 2.02），艾滋病毒感染时间（AOR = 2.02），心理健康护理（AOR = 1.47），心理健康药物（AOR = 1.59）和大量饮酒（AOR = 1.46）相关。住院与高中教育（AOR = 1.57），有保险（AOR = 10.45），无家可归（AOR = 2.18），健康状况差（AOR = 2.64），HIV感染时间（AOR = 2.03）和精神健康药物（AOR = 1.87）相关。在难以接触到的边缘化艾滋病毒感染者中，有保险、病例管理和精神卫生保健与门诊就诊增加有关。这些研究结果支持对边缘化人群的艾滋病毒多学科护理。了解与卫生保健利用相关的因素是至关重要的外展计划，以促进参与艾滋病毒护理。
To benefit from HIV treatment advances individuals must utilize ambulatory primary care services. Few studies focus on marginalized populations, which tend to have poor health care utilization patterns. This study examined factors associated with health care utilization in hard-to-reach marginalized HIV-infected individuals. As part of a multisite initiative evaluating outreach programs that target underserved HIV-infected individuals, 610 participants were interviewed about their HIV disease, health services utilization, substance use, mental health, and case management. Primary outcomes included ambulatory, emergency department, and inpatient visits. Generalized estimating equations were used in logistic regression analyses. On regression analyses ambulatory visits were associated with having insurance (adjusted odds ratio [AOR] = 2.46), mental health medications (AOR = 7.46), and case management (AOR = 4.81). Emergency department visits were associated with having insurance (AOR = 1.74), homelessness (AOR = 2.23), poor health status (AOR = 2.02), length of HIV infection (AOR = 2.02), mental health care (AOR = 1.47), mental health medications (AOR = 1.59), and heavy alcohol intake (AOR = 1.46). Hospitalizations were associated with high school education (AOR = 1.57), having insurance (AOR = 10.45), homelessness (AOR = 2.18), poor health status (AOR = 2.64), length of HIV infection (AOR = 2.03), and mental health medications (AOR = 1.87). In hard-to-reach marginalized HIV-infected individuals, having insurance, case management and mental health care were associated with increased ambulatory visits. These findings support HIV multidisciplinary care with marginalized populations. Understanding factors associated with health care utilization is essential for outreach programs to facilitate engagement in HIV care.