Improving Adherence to HIV Quality of Care Indicators in Persons With Opioid Dependence: The Role of Buprenorphine
| Autor: | Rongwei Fu, Steven M. Asch, David A. Fiellin, Paula J. Lum, P. Todd Korthuis, Margaret Fishl, Mary Jo Tozzi, Joshua Boverman, Frederick L. Altice, Nancy L. Sohler, Timothy P. Flanigan, Michael Botsko, Dennis McCarty |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male medicine.medical_specialty Anti-HIV Agents Narcotic Antagonists HIV Infections Article Cohort Studies Maintenance therapy Antiretroviral Therapy Highly Active Internal medicine Naloxone Health care Opiate Substitution Treatment medicine Humans Pharmacology (medical) Quality of Health Care business.industry Medical record Middle Aged Opioid-Related Disorders Confidence interval Buprenorphine Infectious Diseases Multivariate Analysis Practice Guidelines as Topic Physical therapy Female Buprenorphine Naloxone Drug Combination Guideline Adherence business medicine.drug Cohort study |
| Zdroj: | JAIDS Journal of Acquired Immune Deficiency Syndromes. 56:S83-S90 |
| ISSN: | 1525-4135 |
| DOI: | 10.1097/qai.0b013e31820bc9a5 |
| Popis: | Background: Opioid-dependent HIV-infected patients are less likely to receive HIV quality of care indicators (QIs) compared with nondependent patients. Buprenorphine/naloxone maintenance therapy (bup/nx) could affect the quality of HIV care for opioid-dependent patients. Methods: We abstracted 16 QIs from medical records at nine HIV clinics 12 months before and after initiation of bup/nx versus other treatment for opioid dependence. Summary quality scores (number of QIs received/number eligible × 100) were calculated. We compared change in QIs and summary quality scores in patients receiving bup/nx versus other participants. Results: One hundred ninety-four of 268 participants (72%) received bup/nx and 74 (28%) received other treatment. Mean summary quality scores increased over 12 months for participants receiving bup/nx (45.6% to 51.6%, P < 0.001) but not other treatment (48.6% to 47.8%, P = 0.788). Bup/nx participants experienced improvements in six of 16 HIV QIs versus three of 16 QIs in other participants. Improvements were mostly in preventive and monitoring care domains. In multivariable analysis, bup/nx was associated with improved summary quality score (β 8.55; 95% confidence interval, 2.06-15.0). Conclusions: In this observational cohort study, HIV-infected patients with opioid dependence received approximately half of HIV QIs at baseline. Buprenorphine treatment was associated with improvement in HIV QIs at 12 months. Integration of bup/nx into HIV clinics may increase receipt of high-quality HIV care. Further research is required to assess the effect of improved quality of HIV care on clinical outcomes. |
| Databáze: | OpenAIRE |
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