Benchmarking HIV health care: from individual patient care to health care evaluation. An example from the EuroSIDA study.

Autor: Podlekareva DN; Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark. dpo@cphiv.dk, Reekie J, Mocroft A, Losso M, Rakhmanova AG, Bakowska E, Karpov IA, Lazarus JV, Gatell J, Lundgren JD, Kirk O
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2012 Sep 25; Vol. 12, pp. 229. Date of Electronic Publication: 2012 Sep 25.
DOI: 10.1186/1471-2334-12-229
Abstrakt: Background: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV patients based on four key indicators.
Methods: Four indicators of health care were assessed: Compliance with current guidelines on initiation of: 1) combination antiretroviral therapy (cART); 2) chemoprophylaxis; 3) frequency of laboratory monitoring; and 4) virological response to cART (proportion of patients with HIV-RNA < 500copies/ml for >90% of time on cART).
Results: 7097 EuroSIDA patients were included from Northern (n = 923), Southern (n = 1059), West Central (n = 1290) East Central (n = 1366), Eastern (n = 1964) Europe, and Argentina (n = 495). Patients in Eastern Europe with a CD4 < 200cells/mm(3) were less likely to initiate cART and Pneumocystis jiroveci-chemoprophylaxis compared to patients from all other regions, and less frequently had a laboratory assessment of their disease status. The proportion of patients with virological response was highest in Northern, 89% vs. 84%, 78%, 78%, 61%, 55% in West Central, Southern, East Central Europe, Argentina and Eastern Europe, respectively (p < 0.0001). Compared to Northern, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for Eastern Europe and Argentina (adjusted OR 0.16 [95%CI 0.11-0.23, p < 0.0001]; 0.20[0.14-0.28, p < 0.0001] respectively).
Conclusions: This assessment of HIV health care utilization revealed pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for the assessment and benchmarking of the clinical management of HIV patients in any setting worldwide.
Databáze: MEDLINE
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