Missed visits and mortality among patients establishing initial outpatient HIV treatment.
Missed visits and mortality among patients establishing initial outpatient HIV treatment.
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DOI：
10.1086/595705
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发表时间：
2009-01-15
期刊：
影响因子：
--
通讯作者：
Allison JJ
中科院分区：
文献类型：
--
作者：
Mugavero MJ;Lin HY;Willig JH;Westfall AO;Ulett KB;Routman JS;Abroms S;Raper JL;Saag MS;Allison JJ
预计需要与艾滋病毒治疗联系的患者将急剧增加，这是对最新的CDC艾滋病毒检测建议的回应，该建议倡导常规选择退出检测。一项嵌套在前瞻性HIV临床队列研究中的回顾性分析评价了2000年1月1日至2005年12月31日期间在亚拉巴马大学伯明翰1917 HIV/AIDS诊所接受初始门诊HIV治疗的患者。生存方法被用来评估在其他基线社会人口学、心理社会学和临床因素的背景下，在第一年护理中错过访视对随后死亡率的影响。死亡率是通过查询截至2007年8月1日的社会保障死亡指数确定的。在543名开始门诊艾滋病护理的研究参与者中，60%的人在第一年错过了一次就诊。在建立门诊治疗后的第一年内，错过访视的患者的死亡率为2.3/100人年，而参加所有预定预约的患者的死亡率为1.0/100人年（P=0.02）。在考克斯比例风险分析中，较高的死亡风险与错过访视（HR=2.90，95%CI=1.28-6.56）、年龄较大（HR=1.58/10岁，95%CI=1.12-2.22）和基线CD 4计数<200个细胞/mm 3（HR=2.70，95%CI=1.00-7.30）独立相关。在开始门诊艾滋病毒治疗后的第一年错过就诊的患者的长期死亡率是那些参加所有预约的患者的两倍多。我们认为早期漏诊与观察到的较高死亡率没有因果关系，而是发现患者更有可能表现出预示随后死亡率增加的健康行为。
Dramatic increases in patients requiring linkage to HIV treatment are anticipated in response to updated CDC HIV testing recommendations advocating routine, opt-out testing. A retrospective analysis nested within a prospective HIV clinical cohort study evaluated patients establishing initial outpatient HIV treatment at the University of Alabama at Birmingham 1917 HIV/AIDS Clinic between 1 January 2000 and 31 December 2005. Survival methods were used to evaluate the impact of missed visits in the first year of care on subsequent mortality in the context of other baseline sociodemographic, psychosocial, and clinical factors. Mortality was ascertained by query of the Social Security Death Index as of 1 August 2007. Among 543 study participants initiating outpatient HIV care, 60% missed a visit in the first year. Mortality was 2.3 per 100 person-years for patients who missed visits compared with 1.0 per 100 person-years for those who attended all scheduled appointments during the first year after establishing outpatient treatment (P=0.02). In Cox proportional hazards analysis, higher hazards of death were independently associated with missed visits (HR=2.90, 95%CI=1.28–6.56), older age (HR=1.58 per 10 years, 95%CI=1.12–2.22), and baseline CD4 count <200 cells/mm3 (HR=2.70, 95%CI=1.00–7.30). Patients who missed visits in the first year after initiating outpatient HIV treatment had more than twice the rate of long-term mortality relative to those who attended all scheduled appointments. We posit that early missed visits are not causally responsible for the higher observed mortality, but rather identify patients more likely to exhibit health behaviors that portend increased subsequent mortality.
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影响因子：
4.9
作者：
Bradford, Judith B.;Coleman, Sharon;Cunningham, William
通讯作者：
Cunningham, William
DOI：
10.1097/00126334-200304010-00009
发表时间：
2003-04-01
影响因子：
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作者：
Giordano, TP;White, AC;Visnegarwala, F
通讯作者：
Visnegarwala, F
DOI：
10.1080/09540120412331336652
发表时间：
2005-08-01
影响因子：
1.7
作者：
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通讯作者：
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影响因子：
12.7
作者：
Keruly, JC;Conviser, R;Moore, RD
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Moore, RD
影响因子：
11.8
作者：
Chen, RY;Accortt, NA;Saag, MS
通讯作者：
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