| Autor: |
Horberg MA; 1 Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute , Rockville, Maryland.; 2 Kaiser Permanente Mid-Atlantic Permanente Medical Group , Rockville, Maryland., Blank JG; 1 Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute , Rockville, Maryland., Rubenstein KB; 1 Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute , Rockville, Maryland., Certa JM; 1 Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute , Rockville, Maryland., Hurley LB; 3 Kaiser Permanente Northern California , Division of Research, Oakland, California., Kadlecik PM; 2 Kaiser Permanente Mid-Atlantic Permanente Medical Group , Rockville, Maryland., Klein DB; 4 Kaiser Permanente Northern California , San Leandro, California., Silverberg MJ; 3 Kaiser Permanente Northern California , Division of Research, Oakland, California. |
| Abstrakt: |
Kaiser Permanente Mid-Atlantic States (KPMAS) members are increasingly utilizing electronic encounter types, such as telephone appointments and secure messaging for healthcare purposes, although their impact on health outcomes is unknown. We evaluated whether use of alternative encounters by adult human immunodeficiency virus (HIV)-infected patients affected the likelihood of achieving viral suppression (VS). Our study population of 3114 patients contributed 6520 patient-years between 2014 and 2016. We compared VS (HIV RNA <200 copies/mL) by number of in-person visits (1 or ≥2), with further stratification for additional phone and/or e-mail encounters (none, phone only, e-mail only, and both phone and e-mail). Rate ratios (RRs) for VS by number of in-person visits and encounter types were obtained from Poisson modeling, adjusting for age, sex, race/ethnicity, and HIV risk. Compared to those with ≥2 visits, patients with one in-person visit alone were significantly less likely to achieve VS (RR = 0.93; 95% confidence interval, CI: [0.87-1.00]), as were those with one in-person visit plus a telephone encounter (0.93; [0.90-0.97]). We did not find significant differences in VS comparing patients with one in-person visit plus e-mail only (RR = 1.00; 95% CI: [0.97-1.02]) or plus e-mail and telephone (0.99; [0.97-1.01]) to those with ≥2 in-person visits. If supplemented by e-mail communications (with or without telephone contact), patients with one in-person visit per year had similar estimated rates of VS compared with ≥2 in-person visits. More research is needed to know if these findings apply to other care systems. |
