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

背景：長期監測愛滋病照顧品質及分析進階護理師主導的個案管理模式，對於增加愛滋感染者持續接受醫療照護，並遵從接受抗病毒藥物治療的成效是全球關注重點。目的：分析2008- 2012年持續接受醫療照顧及抑制愛滋病毒複製之趨勢變化，並探討個案管理模式對於愛滋病照顧品質成效。方法：回溯描述性相關研究，共1,302位個案在2008-2012年間至少有一次門診紀錄，其中715位（54.9%）愛滋感染者曾接受個案管理。以趨勢檢定描述長期趨勢及邏輯式回歸，分析個案管理對愛滋照顧品質之影響。結果：持續接受醫療照護比率，從2008年44.5%逐年上升至2012年57.3%，服藥滿12個月抑制愛滋病毒複製比率，從2008年88.4%到2012年93.5%。接受愛滋個案管理者其持續接受醫療照護比率顯著高於未接受個案管理者（73.6% vs. 31.7%, p < .001），持續接受愛滋照顧是影響一年內達到抑制愛滋病毒複製之重要因素[adjusted odds ratio (AOR) = 5.4, 95% CI = 2.6-10.9, p < .001]。結論／實務應用進階護理師主導的愛滋個案管理計劃為有效照顧模式，使個案持續留在醫療體系，並達到早期抑制愛滋病毒複製之效果。

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.