domingo, 1 de abril de 2012

Comparing different measures of retention in outpatient... [AIDS. 2012] - PubMed - NCBI

Comparing different measures of retention in outpatient... [AIDS. 2012] - PubMed - NCBI

New AHRQ Study Finds Only 75 Percent of HIV Patients Stay in Care
Only 75 percent of HIV/AIDS patients in the United States remain in care consistently, according to a new AHRQ-supported study published in the February 29 issue of the journal AIDS. The study is the first to provide a comprehensive national estimate of HIV care retention and information about patients who are most likely to continue their care over time. Researchers studied 17,425 adult patients cared for at 12 clinics within the AHRQ-supported HIV Research Network between 2001 and 2008. Only 42 percent of patients studied had what researchers defined as no "gap" in treatment - or intervals of no more than six months in between outpatient visits - over the seven-year period. Nearly one-third, or 31 percent of patients, had one or more treatment gap that extended between seven and 12 months. And about 28 percent of patients appeared to have gone without care for more than a year on one or more occasions. Women, white patients, older patients, male patients who were infected via sex with men, and patients who began treatment on Medicare (compared to those on private insurance) all were more likely to remain in care more consistently. Retention was also greater among patients whose CD4 counts-the measure of how advanced the disease is-were very low when they entered care. The study was led by Baligh Yehia, M.D., a post-doctoral fellow at the University of Pennsylvania Perelman School of Medicine, and Kelly Gebo, M.D., an associate professor of medicine at the Johns Hopkins University School of Medicine. Select to access the abstract on PubMed.®

AIDS. 2012 Feb 29. [Epub ahead of print]

Comparing different measures of retention in outpatient HIV care.

Yehia BR, Fleishman JA, Metlay JP, Korthuis PT, Agwu AL, Berry SA, Moore RD, Gebo KA; for the HIV Research Network.

Source

aDepartment of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania bCenter for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland cDepartment of Medicine, Oregon Health and Sciences University, Portland, Oregon dDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Abstract

OBJECTIVES:

The US National HIV/AIDS Strategy identifies retention in care as an important quality performance measure. There is no gold standard to measure retention in care. This study is the first to compare different measures of retention, using a large geographically diverse sample.

DESIGN:

A prospective cohort of 17 425 HIV-infected adults enrolled in care at 12 US HIV clinics between 2001 and 2008.

METHODS:

We compared three measures of retention for each patient: proportion of time not spent in a gap of more than 6 months between successive outpatient visits; proportion of 91-day quarters in which at least one visit occurred; proportion of years in which two or more visits separated by at least 90 days occurred. Associations among measures and effects of sociodemographic and clinical characteristics were examined.

RESULTS:

The three measures of retention were moderately to strongly correlated. Averaging across patients, 71% of time in care was not spent in a gap more than 6 months; 73% of all quarters had at least one visit; and 75% of all years had at least two visits separated by at least 90 days. For all measures, retention was significantly higher for women, whites, older individuals, men who had sex with men (MSM)-related HIV transmission, and initial CD4 cell counts 50 cell/μl or less.

CONCLUSIONS:

This is the first study to provide a national estimate of retention in HIV care in the US, which ranged from 71 to 75% using any of the accepted retention measures. Future studies should assess how well different measures predict clinical outcomes and establish acceptable target levels for retention.