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Li MC, Wang LY, Ko NY, Ko WC. The impact of physician subspeciality on the quality of diabetes care for people living with HIV. J Formos Med Assoc 2021; 120:2016-2022. [PMID: 34636727 DOI: 10.1016/j.jfma.2019.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/29/2019] [Accepted: 12/09/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Management of comorbidities of people living with HIV (PLHIV) involves different care models, including providing diabetes care and HIV care by the same infectious diseases physician (IDP) ("consolidated care") or providing diabetes care by the physicians other than IDP ("shared care"). The impact of diabetes care model on PLHIV with diabetes mellitus (DM) has not been well-evaluated. METHODS A nationwide cross-sectional sample in the Taiwan National Health Insurance Research Database was used to compare the performance rates of seven guideline-recommended tests provided by the different subspecialists. RESULTS Of 523 PLHIV with DM, there were 54.88% (n = 287) in the consolidated care group and 45.12% (n = 236) in the shared care group. More patients in the consolidated care group received the tests of lipid profile (92.33% vs. 79.24%), creatinine (Cr) (93.73% vs. 78.39%), and alanine transaminase (ALT) (91.99% vs. 75.42%), but fewer received urine protein test (35.54% vs. 51.69%) and fundoscopic examination (8.01% vs. 33.90%). The two groups did not differ in the performance rates of serum fasting glucose and HbA1c. After controlling for demographic factors and diabetic severity, the consolidated group was less likely to miss the serum tests of lipid profile (odds ratio [OR]: 0.30), Cr (OR: 0.19), and ALT (OR: 0.23), but more often missed urine protein test (OR: 1.56) and fundoscopic examination (OR: 4.97). CONCLUSION These findings suggest the need to focus on different process indicators of diabetes cares in different care models to enhance the diabetes care for PLHIV.
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Affiliation(s)
- Ming-Chi Li
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Liang-Yi Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Nai-Ying Ko
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Webel AR, Schexnayder J, Rentrope CR, Bosworth HB, Hileman CO, Okeke NL, Vedanthan R, Longenecker CT. The influence of healthcare financing on cardiovascular disease prevention in people living with HIV. BMC Public Health 2020; 20:1768. [PMID: 33228623 PMCID: PMC7685650 DOI: 10.1186/s12889-020-09896-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People living with HIV are diagnosed with age-related chronic health conditions, including cardiovascular disease, at higher than expected rates. Medical management of these chronic health conditions frequently occur in HIV specialty clinics by providers trained in general internal medicine, family medicine, or infectious disease. In recent years, changes in the healthcare financing for people living with HIV in the U.S. has been dynamic due to changes in the Affordable Care Act. There is little evidence examining how healthcare financing characteristics shape primary and secondary cardiovascular disease prevention among people living with HIV. Our objective was to examine the perspectives of people living with HIV and their healthcare providers on how healthcare financing influences cardiovascular disease prevention. METHODS As part of the EXTRA-CVD study, we conducted in-depth, semi-structured interviews with 51 people living with HIV and 34 multidisciplinary healthcare providers and at three U.S. HIV clinics in Ohio and North Carolina from October 2018 to March 2019. Thematic analysis using Template Analysis techniques was used to examine healthcare financing barriers and enablers of cardiovascular disease prevention in people living with HIV. RESULTS Three themes emerged across sites and disciplines (1): healthcare payers substantially shape preventative cardiovascular care in HIV clinics (2); physician compensation tied to relative value units disincentivizes cardiovascular disease prevention efforts by HIV providers; and (3) grant-based services enable tailored cardiovascular disease prevention, but sustainability is limited by sponsor priorities. CONCLUSIONS With HIV now a chronic disease, there is a growing need for HIV-specific cardiovascular disease prevention; however, healthcare financing complicates effective delivery of this preventative care. It is important to understand the effects of evolving payer models on patient and healthcare provider behavior. Additional systematic investigation of these models will help HIV specialty clinics implement cardiovascular disease prevention within a dynamic reimbursement landscape. TRIAL REGISTRATION Clinical Trial Registration Number: NCT03643705 .
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Affiliation(s)
- Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
| | - Julie Schexnayder
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - C Robin Rentrope
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Corrilynn O Hileman
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,The MetroHealth System, Cleveland, OH, USA
| | | | - Rajesh Vedanthan
- New York University Grossman School of Medicine, New York, NY, USA
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Chowers M, Chemtob D, Mor O, Levy I, Elbirt D, Elinav H, Rizenberg K, Lorber M, Istomin V, Nemet S, Shahak G, Turner D. Continuum of HIV care of newly diagnosed individuals in Israel, 2011-2015: a population-based cohort study. Int J STD AIDS 2020; 31:326-334. [PMID: 32090684 DOI: 10.1177/0956462419891023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our aim was to assess the linkage to care (LTC) and treatment for people newly diagnosed with HIV in Israel during 2011–2015. The Ministry of Health estimated the annual prevalence of undiagnosed HIV; new diagnoses were identified by the Central Virology Laboratory. Only adult Israeli citizens were included. LTC at HIV centers within 90 days of diagnosis was assessed. Demographic and clinical data were collected from patient files. A total of 1538 individuals were diagnosed in 2011–2015. A moderate improvement over time was observed in the calculated proportions of undiagnosed individuals (23.1–17.3%) but no change occurred in LTC rates (82.6–81%). The proportion of diagnosed patients initiating treatment within six months increased from 54.7% in 2011 to 89.7% in 2015, with a parallel increase in the viral suppression rate from 30.5% in 2011 to 59.9% in 2015. Of 1159 patients with detailed records, 79.4% were men, median age 36 years (16–92), median CD4 cell count 342 cells/µl. Younger age, intravenous drug use, and imprisonment were independent risk factors for loss to follow-up. HIV is diagnosed late in Israel and LTC rates remain stagnated; higher awareness is still needed. Once in care, however, treatment and outcomes were in line with international standards.
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Affiliation(s)
- M Chowers
- Meir Medical Center, Kfar Saba, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - O Mor
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel
| | - I Levy
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sheba Medical Center, Tel-Hashomer, Israel
| | - D Elbirt
- Faculty of Medicine, Hebrew University, Jerusalem, Israel.,Kaplan Medical Center, Rehovot, Israel
| | - H Elinav
- Faculty of Medicine, Hebrew University, Jerusalem, Israel.,Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - K Rizenberg
- Soroka Medical Center, Beer-Sheva, Israel.,Faculty of Medicine, Ben-Gurion University, Beer-Sheva, Israel
| | - M Lorber
- Rambam Medical Center, Haifa, Israel.,Technion, Haifa, Israel
| | - V Istomin
- Technion, Haifa, Israel.,Hillel Yaffe Medical Center, Hadera, Israel
| | - S Nemet
- Kaplan Medical Center, Rehovot, Israel
| | - G Shahak
- Sheba Medical Center, Tel-Hashomer, Israel
| | - D Turner
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Tel Aviv Medical Center, Tel Aviv, Israel
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4
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Horberg MA, Blank JG, Rubenstein KB, Certa JM, Hurley LB, Kadlecik PM, Klein DB, Silverberg MJ. Impact of Alternative Encounter Types on HIV Viral Suppression Rates in an Integrated Health System. AIDS Patient Care STDS 2018; 32:425-431. [PMID: 30398954 DOI: 10.1089/apc.2018.0079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- Michael A. Horberg
- Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, Maryland
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Jackie G. Blank
- Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, Maryland
| | - Kevin B. Rubenstein
- Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, Maryland
| | - Julia M. Certa
- Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, Maryland
| | - Leo B. Hurley
- Kaiser Permanente Northern California, Division of Research, Oakland, California
| | - Peter M. Kadlecik
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Daniel B. Klein
- Kaiser Permanente Northern California, San Leandro, California
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5
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Appenheimer AB, Bokhour B, McInnes DK, Richardson KK, Thurman AL, Beck BF, Vaughan-Sarrazin M, Asch SM, Midboe AM, Taylor T, Dvorin K, Gifford AL, Ohl ME. Should Human Immunodeficiency Virus Specialty Clinics Treat Patients With Hypertension or Refer to Primary Care? An Analysis of Treatment Outcomes. Open Forum Infect Dis 2017; 4:ofx005. [PMID: 28480278 DOI: 10.1093/ofid/ofx005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/19/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Care for people with human immunodeficiency virus (HIV) increasingly focuses on comorbidities, including hypertension. Evidence indicates that antiretroviral therapy and opportunistic infections are best managed by providers experienced in HIV medicine, but it is unclear how to structure comorbidity care. Approaches include providing comorbidity care in HIV clinics ("consolidated care") or combining HIV care with comorbidity management in primary care clinics ("shared care"). We compared blood pressure (BP) control in HIV clinics practicing consolidated care versus shared care. METHODS We created a national cohort of Veterans with HIV and hypertension receiving care in HIV clinics in Veterans Administration facilities and merged these data with a survey asking HIV providers how they delivered hypertension care (5794 Veterans in 73 clinics). We defined BP control as BP ≤140/90 mmHg on the most recent measure. We compared patients' likelihood of experiencing BP control in clinics offering consolidated versus shared care, adjusting for patient and clinic characteristics. RESULTS Forty-two of 73 clinics (57.5%) practiced consolidated care for hypertension. These clinics were larger and more likely to use multidisciplinary teams. The unadjusted frequency of BP control was 65.6% in consolidated care clinics vs 59.4% in shared care clinics (P < .01). The likelihood of BP control remained higher for patients in consolidated care clinics after adjusting for patient and clinic characteristics (odds ratio, 1.32; 95% confidence interval, 1.04-1.68). CONCLUSIONS Patients were more likely to experience BP control in clinics reporting consolidated care compared with clinics reporting shared care. For shared-care clinics, improving care coordination between HIV and primary care clinics may improve outcomes.
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Affiliation(s)
- A Ben Appenheimer
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Barbara Bokhour
- Boston University School of Public Health, Department of Health Law, Policy, and Management, Massachusetts.,Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Healthcare System, Bedford, Massachusetts
| | - D Keith McInnes
- Boston University School of Public Health, Department of Health Law, Policy, and Management, Massachusetts.,Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Healthcare System, Bedford, Massachusetts
| | - Kelly K Richardson
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa
| | - Andrew L Thurman
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa
| | - Brice F Beck
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa
| | - Mary Vaughan-Sarrazin
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Steven M Asch
- Division of General Medical Science, Department of Medicine, Stanford University School of Medicine, Palo Alto, California.,Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
| | - Amanda M Midboe
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
| | - Thom Taylor
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
| | - Kelly Dvorin
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Healthcare System, Bedford, Massachusetts
| | - Allen L Gifford
- Boston University School of Public Health, Department of Health Law, Policy, and Management, Massachusetts.,Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Healthcare System, Bedford, Massachusetts
| | - Michael E Ohl
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
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