Multimorbidity, not human immunodeficiency virus (HIV) markers predicts unplanned admission among people with HIV in regional New South Wales

Edmiston, Natalie; Petoumenos, Kathy; Smith, David J.

doi:10.1111/imj.13733

Cited by 6 publications

(5 citation statements)

References 38 publications

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“…Even with access to effective ART, PLHIV are more likely than people without HIV to experience depression and other mental health disorders, including substance use disorders 16 . Irrespective of whether these conditions precede the HIV infection, which may affect prevention and treatment, multimorbidity in PLHIV is associated with higher levels of hospitalization 38 , higher healthcare costs 39 , higher levels of polypharmacy 40 , and lower HRQoL 7,13 .…”

Section: Resultsmentioning

confidence: 99%

Consensus statement on the role of health systems in advancing the long-term well-being of people living with HIV

et al. 2021

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Health systems have improved their abilities to identify, diagnose, treat and, increasingly, achieve viral suppression among people living with HIV (PLHIV). Despite these advances, a higher burden of multimorbidity and poorer health-related quality of life are reported by many PLHIV in comparison to people without HIV. Stigma and discrimination further exacerbate these poor outcomes. A global multidisciplinary group of HIV experts developed a consensus statement identifying key issues that health systems must address in order to move beyond the HIV field’s longtime emphasis on viral suppression to instead deliver integrated, person-centered healthcare for PLHIV throughout their lives.

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Section: Resultsmentioning

confidence: 99%

Consensus statement on the role of health systems in advancing the long-term well-being of people living with HIV

et al. 2021

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“…To ensure consistency, benchmarking of CIRS assessments was conducted between the two principal assessors. Among PLWH in Australia, CIRS has been shown to be associated with age and past AIDS [6] and to predict unplanned admission [7].…”

Section: Variablesmentioning

confidence: 99%

“…There are approximately 28 000 PLWH currently living in Australia, with 21.9% of these residing in regional/rural areas [5]. PLWH in regional and remote areas are older, under greater financial stress, have decreased access to a primary care doctor for HIV management, have more frequent unplanned admissions and experience greater levels of multimorbidity than their metropolitan‐based peers [5–7]. Multimorbidity is commonly defined as the presence of more than one health condition in the same individual, and in the context of HIV would be in addition to their HIV diagnosis [8].…”

Section: Introductionmentioning

confidence: 99%

What are the predictors of change in multimorbidity among people with HIV? A longitudinal observational cohort study

Casten

Herbert²,

Smith³

et al. 2023

HIV Medicine

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Introduction: Multimorbidity is common among people living with HIV (PLWH), with numerous cross-sectional studies demonstrating associations with older age and past immunosuppression. Little is known about the progression of multimorbidity, particularly in the setting of long-term access to antiretrovirals. This study aims to determine factors predictive of change in multimorbidity in PLWH.Methods: People living with HIV who attended a regional HIV service were recruited to a consented observational cohort between September 2016 and March 2020. Demographic data, laboratory results and a Cumulative Illness Rating Scale (CIRS) were collected at enrolment and first clinical review of every subsequent year. Change in CIRS score was calculated from enrolment to February 2021. Associations with change were determined through univariate and multivariate linear regression.Results: Of 253 people, median age was 58.9 [interquartile range (IQR): 51.9-64.4] years, 91.3% were male, and HIV was diagnosed a median of 22.16 years (IQR: 12.1-30.9) beforehand. Length of time in the study was a median of 134 weeks (IQR: 89.0-179.0), in which a mean CIRS score change of 1.21 (SD 2.60) was observed. Being older (p < 0.001) and having a higher body mass index (p = 0.008) and diabetes (p = 0.014) were associated with an increased likelihood of worsening multimorbidity. PLWH with a higher level of multimorbidity at baseline were less likely to worsen over time (p < 0.001). Conclusion: As diabetes and weight predict worsening multimorbidity, routine diabetes screening, body mass index measurement, and multimorbidity status awareness are recommended.

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“…Often these populations are high users of acute health care. [53][54][55][56][57][58] High rates of acute care are accessed because this care is perceived by the consumer as more accessible, less costly and of higher quality. 59,60 For many, it could be argued that acute care is not necessarily the right care or the right setting, departing from the ideal of PCC and placing significant burden on the acute care setting.…”

Section: Communities and Complexitymentioning

confidence: 99%

Integrating patient complexity into health policy: a conceptual framework

Maree

Hughes²,

Radford³

et al. 2020

Aust. Health Rev.

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ObjectiveClinicians across all health professions increasingly strive to add value to the care they deliver through the application of the central tenets of people-centred care (PCC), namely the ‘right care’, in the ‘right place’, at the ‘right time’ and ‘tailored to the needs of communities’. This ideal is being hampered by a lack of a structured, evidence-based means to formulate policy and value the commissioning of services in an environment of increasing appreciation for the complex health needs of communities. This creates significant challenges for policy makers, commissioners and providers of health services. Communities face a complex intersection of challenges when engaging with healthcare. Increasingly, complexity is gaining prominence as a significant factor in the delivery of PCC. Based on the World Health Organization (WHO) components of health policy, this paper proposes a policy framework that enables policy makers, commissioners and providers of health care to integrate a model of complexity into policy, subsequent service planning and development of models of care. MethodsThe WHO components of health policy were used as the basis for the framework. Literature was drawn on to develop a policy framework that integrates complexity into health policy. ResultsWithin the framework, complexity is juxtaposed between the WHO components of ‘vision’, ‘priorities’ and ‘roles’. ConclusionThis framework, supported by the literature, provides a means for policy makers and health planners to conduct analyses of and for policy. Further work is required to better model complexity in a manner that integrates consumer needs and provider capabilities. What is known about the topic?There is a growing body of evidence regarding patient complexity and its impact on the delivery of health services, but there is little consideration of patient complexity in policy, which is an important consideration for service provision. What does this paper add?This paper presents an argument for the inclusion of patient complexity in health policy and provides a framework for how that might occur. What are the implications for practitioners?The inclusion of patient complexity in policy could provide a means for policy makers to consider the factors that contribute to patient complexity in service provision decisions.

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Multimorbidity, not human immunodeficiency virus (HIV) markers predicts unplanned admission among people with HIV in regional New South Wales

Abstract: Unplanned admission among PWH is predicted by multimorbidity. Care for PWH should include coordinated management of other health conditions in order to reduce their severity and prevent unplanned admissions.

Cited by 6 publications

References 38 publications

Consensus statement on the role of health systems in advancing the long-term well-being of people living with HIV

Consensus statement on the role of health systems in advancing the long-term well-being of people living with HIV

What are the predictors of change in multimorbidity among people with HIV? A longitudinal observational cohort study

Integrating patient complexity into health policy: a conceptual framework

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