Abstract
ABSTRACTOBJECTIVE To analyze whether sociodemographic characteristics, consultations and care in special services are associated with scheduled infectious diseases appointments missed by people living with HIV.METHODS This cross-sectional and analytical study included 3,075 people living with HIV who had at least one scheduled appointment with an infectologist at a specialized health unit in 2007. A secondary data base from the Hospital Management & Information System was used. The outcome variable was missing a scheduled medical appointment. The independent variables were sex, age, appointments in specialized and available disciplines, hospitalizations at the Central Institute of the Clinical Hospital at the Faculdade de Medicina of the Universidade de São Paulo, antiretroviral treatment and change of infectologist. Crude and multiple association analysis were performed among the variables, with a statistical significance of p ≤ 0.05.RESULTS More than a third (38.9%) of the patients missed at least one of their scheduled infectious diseases appointments; 70.0% of the patients were male. The rate of missed appointments was 13.9%, albeit with no observed association between sex and absences. Age was inversely associated to missed appointment. Not undertaking anti-retroviral treatment, having unscheduled infectious diseases consultations or social services care and being hospitalized at the Central Institute were directly associated to missed appointments.CONCLUSIONS The Hospital Management & Information System proved to be a useful tool for developing indicators related to the quality of health care of people living with HIV. Other informational systems, which are often developed for administrative purposes, can also be useful for local and regional management and for evaluating the quality of care provided for patients living with HIV.
Highlights
In terms of universal access to highly active antiretroviral therapy (HAART), one challenge to achieving greater effectiveness and impact from the therapy for people living with HIV (PLHIV) is maintaining high HAART adherence rates.[8,18]
HAART success was associated with consultation attendance rates.[1,18]
How the health service, directed towards PLHIV care, is organized is an important aspect related to HAART adherence.[19]
Summary
In terms of universal access to highly active antiretroviral therapy (HAART), one challenge to achieving greater effectiveness and impact from the therapy for people living with HIV (PLHIV) is maintaining high HAART adherence rates.[8,18] HAART success was associated with consultation attendance rates.[1,18] In addition, the number of missed consultations was associated with a risk of death,[17,20,23] and the total days lost between missing an appointment and the following one was associated with new AIDS-defining illnesses.[20]. From a management point of view, scheduled consultation absences are a problem for both health services and society, these aspects can be translated into financial costs.[2,22] How the health service, directed towards PLHIV care, is organized is an important aspect related to HAART adherence.[19] Barriers to service access and to information, lack of regularity in attending scheduled consultations and in collecting medications can be negatively associated to HAART adherence.[8]
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