Retention challenges for a community-based HIV primary care clinic and implications for intervention
Retention challenges for a community-based HIV primary care clinic and implications for intervention
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DOI：
10.1089/apc.2006.0205
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发表时间：
2007-09-01
影响因子：
4.9
通讯作者：
Bradford, Judith
中科院分区：
文献类型：
--
作者：
Coleman, Sharon;Boehmer, Ulrike;Bradford, Judith
本研究旨在阐明在马萨诸塞州波士顿市芬威社区卫生中心（FCH）接受医疗护理的hiv感染患者中随访缺失（LTF）的相关因素。2005年，瑞士卫生保健中心为1143名艾滋病毒感染者提供了护理，主要是男男性行为的白人男子。有两种方法被用来解决这个研究问题。首先，从2001年到2005年，495名患者被确定为LTF。179名符合条件的患者完成了一份调查问卷，以确定停止治疗的原因，应答率为51%。其次，利用2000年接受医疗护理的896名艾滋病毒感染患者的医疗记录数据进行了一项队列研究。随访至2005年1月1日，使用Cox比例风险回归模型检验LTF的预测因子。调查受访者报告说，在FCH接受护理的最大障碍是个人/文化、结构和财务。22%的人报告在其他地方有零星的护理，护理间隔为6个月或更长时间，8%的人报告没有定期的艾滋病毒提供者。回归分析中LTF的重要预测因子包括：少数民族/民族、使用安全网保险、预约不遵约和没有医疗社会工作访问。为了提高对护理的参与和保留，组织可以使用患者调查进行组织自我评估，以实现操作上的变化，最大限度地减少护理障碍。可以实施基于循证方法的风险评估工具，以确定高风险患者，进行创新的外展干预。研究的主要限制是少数民族和传统上服务不足的人口代表性不足。
The present study sought to elucidate factors involved in loss to follow-up (LTF) among HIV-infected patients who had been receiving medical care at Fenway Community Health (FCH) located in Boston, Massachusetts. FCH provided care to 1143 HIV-infected patients in 2005, predominantly Caucasian men who have sex with men (MSM). Two approaches were used to address the research question. First, 495 patients were identified that had been LTF from 2001-2005. One hundred seventy-nine eligible patients completed a questionnaire to determine reasons for discontinuing care, representing a 51% response rate. Second, a cohort study was performed using the medical record data of 896 HIV-infected patients who were receiving medical care in the year 2000. Patients' utilization of primary medical care was followed until January 1, 2005 and predictors of LTF were examined using Cox proportional hazards regression modeling. Survey respondents reported that the greatest perceived barriers to care at FCH were personal/cultural, structural, and financial in nature. Twenty-two percent reported sporadic care elsewhere with gaps in care of 6 months or more, and 8% reported no regular provider for HIV. Significant predictors of LTF from regression analysis included: minority race/ethnicity, use of safety-net insurance, appointment nonadherence and no medical social work visits. To improve engagement and retention in care, organizations may use patient surveys for organizational self-assessment to effect operational changes that minimize barriers to care. A risk assessment tool based on evidence-based methods can be implemented to identify high-risk patients for innovative outreach interventions. The primary study limitation is the underrepresentation of minority and traditionally underserved populations.