進階護理師主導的個案管理模式提升愛滋病照護品質之成效

The Impact of Nurse-led Case Management on the Quality of HIV Care

10.6224/JN.61.3.69

陳嬿今(Yen-Chin Chen)；賴怡因(Yi-Yin Lai)；劉曉穎(Hsiao-Ying Liu)；白芸慧(Yun-Hui Pai)；柯文謙(Wen-Chien Ko)；柯乃熒(Nai-Ying Ko)

愛滋病 ； 個案管理 ； 持續接受照顧 ； 抑制愛滋病毒複製 ； HIV/AIDS ； case management ； retention in care ； viral suppression

護理雜誌

61卷3期（2014 / 06 / 01）

69 - 78

繁體中文

Background: Monitoring the quality of human immunodeficiency virus (HIV) care and evaluating the effectiveness of HIV case management programs (CMPs) as approaches to raising the rate of HIV care retention and to improving the efficacy of viral suppression after the initiation of highly active antiretroviral therapy (HAART) are important focuses of research worldwide. Purpose: This study describes the trends and evaluates the influence of CMPs on retention in care and viral suppression among patients in Taiwan diagnosed with HIV from 2008 to 2010. Methods: This retrospective study enrolled 1,302 HIV-positive individuals who had visited at least one outpatient clinic between 2008 and 2012. Of these patients, 715 (54.9%) were enrolled in an HIV CMP. Trend analysis and logistic regression were applied to investigate longitudinal trends and the impact of CMPs on the quality of HIV care. Results: Retention in care improved substantially from 44.5% in 2008 to 57.3% in 2012. The percentage of viral suppression within 12 months of the initiation of HAART increased from 88.4% in 2008 to 93.5% in 2012. Of the patients who were in HIV CMPs, 73.6% were retained in care, which was significantly higher than the 31.7% among those who were not enrolled in CMPs (p ＜ .001). Among the patients who received HAART for more than 180 days, those who achieved viral suppression within 12 months were significantly more likely to be retained in care (adjusted odds ratio = 5.36, 95% CI = 2.6-10.9, p ＜ .001). Conclusions and Implications for Practice: Nurse-led case management programs play a role in improving HIV-related health outcomes. HIV CMPs are beneficial to HIV-infected patients by improving retention in care and are indirectly associated with successful viral suppression.

Background: Monitoring the quality of human immunodeficiency virus (HIV) care and evaluating the effectiveness of HIV case management programs (CMPs) as approaches to raising the rate of HIV care retention and to improving the efficacy of viral suppression after the initiation of highly active antiretroviral therapy (HAART) are important focuses of research worldwide. Purpose: This study describes the trends and evaluates the influence of CMPs on retention in care and viral suppression among patients in Taiwan diagnosed with HIV from 2008 to 2010. Methods: This retrospective study enrolled 1,302 HIV-positive individuals who had visited at least one outpatient clinic between 2008 and 2012. Of these patients, 715 (54.9%) were enrolled in an HIV CMP. Trend analysis and logistic regression were applied to investigate longitudinal trends and the impact of CMPs on the quality of HIV care. Results: Retention in care improved substantially from 44.5% in 2008 to 57.3% in 2012. The percentage of viral suppression within 12 months of the initiation of HAART increased from 88.4% in 2008 to 93.5% in 2012. Of the patients who were in HIV CMPs, 73.6% were retained in care, which was significantly higher than the 31.7% among those who were not enrolled in CMPs (p ＜ .001). Among the patients who received HAART for more than 180 days, those who achieved viral suppression within 12 months were significantly more likely to be retained in care (adjusted odds ratio = 5.36, 95% CI = 2.6-10.9, p ＜ .001). Conclusions and Implications for Practice: Nurse-led case management programs play a role in improving HIV-related health outcomes. HIV CMPs are beneficial to HIV-infected patients by improving retention in care and are indirectly associated with successful viral suppression.