High standards of care associated with lower risk of mortality in HIV patients

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, SeropositivoOrgQuality of care (QOC) in the first twelve months after HIV CARE is associated with an increased risk of mortality, according to researchers from the US Department of Veterans Affairs in the report of the online edition of Clinic Infectious diseases. Patients who received at least 80% of the recommended quality indicators (IQs) were 25% less likely to die during the follow-up period when compared to patients who received less than 80% of IQs. Good results were seen in patients with alcohol or medication problems who received high levels of care.

"The current study finds that HIV-infected patients who receive high QOC experience the highest mortality," comment the authors. "High quality of care provided by health systems and providers can translate into reduced mortality for patients."

But a good quality of care was unable to overcome the deficits in mortality associated with disease severity and comorbidities.

On the other hand, the author of an editorial suggests that the quality of care and indicators may need to be changed in order to keep pace with the ever-increasing medical needs associated with HIV infection.

Health care providers in the USA are encouraged to report, via reports, on the quality of care measures. Although the quality of care and HIV infection indicators are well established, the relationship between care indicators and the subsequent risk of mortality has not been well described. But more importantly, it is not known whether the good quality of care can overcome the greater risk of mortality seen in HIV-infected patients with medication and / or alcohol problems.

To answer these questions, investigations in the Cohort of the Veterans Aging Study cohort developed in a comparative study between risk of mortality in HIV-positive patients according to the quality of care provided in the first twelve months after entering the HIV CARE.

Patients who entered between 2002 and 2008 were recruited for the study. Nine quality care indicators were assessed:

  • Reception of antiretroviral therapy (ART).
  • Prophylaxis against pneumocystosis is justified by the low CD4 count.
  • Prophylaxis against MAC (Mycobacterium Avyum Complex) is justified by the low CD4 count.
  • Vaccination against pneumococcus.
  • Annual flu vaccine.
  • Periodic testing for blood lipids.
  • Continuous monitoring for hepatitis C virus (HCV) co-infections.
  • Appropriate clinic for HIV treatment.
  • Monitoring of CD4 count.

Data were also collected on the use of drugs, alcohol and comorbid drugs.

. Patients were followed up until 2014.

The researchers compared the risk of mortality between individuals who received 80% or more of the quality of care indicators in the first twelve months of care and individuals who did not receive this standard of care.

A total of 3038 patients were recruited for the study. Most are male (98%) and black (67%). The Middle Ages were 49 years old. Alcohol abuse was present in 28% of patients and 26% reported use of psychotropic substances; 11% reported drug and alcohol problems.

Patients were followed for an average of eight years. There were 902 deaths (30% of the cohort) during 24805 person-years of follow-up.

About 70% of the patients received 80% or more of the care indicators in the first year.

In general, receiving 80% or more of the recommended care indicators was associated with a 25% reduction in the risk of mortality compared to lower standards of care (age-adjusted risk ratio 0,75; 95% CI, 0,65 , 0,86 -1,18). The association between the highest quality of care and the lowest risk of mortality was independent of drugs or alcohol abuse. However, the quality of care was unable to overcome the higher risk of mortality associated with the severity of the disease (adjusted for age: risk ratio 95; 1.15% CI, 1.21 -XNUMX).

"The year 2010 US National HIV / AIDS Strategy identifies improving the QOC [quality of care] for people living with HIV as a national priority", conclude the authors.

“The current study suggests that this policy may still improve survival among HIV-infected patients who dedicate themselves to care, but that increasing adherence to the quality of care measured may not be sufficient to improve mortality levels without facing underlying conditions. . ”

The editorial describes the lower mortality associated with quality health care shortly after entering HIV CARE as "commendable." But the author notes:

The results "do not offer an indication of quality of sustained care." In addition, because HIV has become chronic, throughout life, for most patients it is no longer adequate to monitor outcomes based solely on care during the first year of follow-up. The author writes: “Our service quality indicators will have to change”.

Michael Carter

Posted in: 28 2015 September

Reference

Korthuis PT et al. Quality of HIV care and mortality in HIV-infected patients. Clin infect Dis, online edition, by 2015.

Horberg MA. HIV quality measures and outcomes - the next phase . Clin infect Dis, online edition, 2015

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