CBO-richtlijn: 'Antiretrovirale behandeling in Nederland'

In collaboration with the Dutch Institute for Health Care Improvement (CBO) and on the basis of recent developments, new guidelines have been developed for the diagnosis and treatment of HIV-infected patients. The most important recommendations are: - Treatment of adult patients is indicated if HIV load > 30,000 RNA copies/ml, or when CD4+ cell count is 5,000 copies/ml, even when CD4+ cell count is > 500 x 106 cells/l. - Optimal antiretroviral treatment consists of a combination of two nucleoside reverse transcriptase inhibitors (NRTIs) and one protease inhibitor, or a combination of two NRTIs and one non-nucleoside reverse transcriptase inhibitor. - Patients on antiretroviral treatment should be monitored every 3 months. - Undetectable HIV load should be the target of first- or second-line antiretroviral treatment. - In order to prevent HIV transmission from mother to child, prescription of antiretroviral drugs after the first three months of pregnancy is indicated in pregnant women with a detectable HIV load. - Prophylaxis of opportunistic infections can be discontinued if CD4+ cell count recovers above 200 × 106/l. - In case of exposure to HIV due to a needle or other occupational accident or unsafe sexual contact, post-exposure prophylaxis should be offered after careful risk evaluation. - Preferably, vaccination to prevent pneumococci infections, influenza, hepatitis A or hepatitis B should be given when CD4+ cell count is > 200 x 106/l

In-patient care for symptomatic, HIV-infected persons: A longitudinal study of hospitalizations, in-patient drug use, and related costs

Patterns in the costs of hospital in-patient care and in-patient drug treatment of 121 symptomatic, HIV-infected patients are described for a university hospital between 1987 and 1991. Trend analyses have been performed on quarterly and yearly data using parametric and non-para-metric statistical techniques. During the 5-year study period the demand for hospital beds almost quadrupled despite a constant number of admissions per person-year and a 40% decrease in the average length of stay. The demand for beds was highest in the autumn and winter months. The impact of female and/or heterosexual subgroups on the yearly utilization of resources increased and reasons for hospitalization became more diverse; there were fewer hospitalizations for Pneumocystis carinii pneumonia infection. Antimicrobial drug treatment accounted for the increased drug treatment costs. The implications for AIDS-treating specialists, hospital managers, and scenario analysts are discussed

Lifetime hospitalization profiles for symptomatic, HIV-infected persons

We explored the relationship between the incidence of hospitalization and disease progression in a group of 140 symptomatic, HIV infected patients by linking hospitalizations to the time of diagnosis, the time of death, or both. The relationship could best be described by positively skewed U-patterns or (weak) J-patterns with a high use of resources immediately following diagnosis and preceding death. The lifetime hospitalization profiles differed according to the type of insurance age, the initial diagnosis in the CDC-IV stage and the length of survival. The results not only confirm general hypotheses posed by other research groups, but also demonstrate the-existence of variations among subgroups of patients. The results can be used to improve economic assessments of the impact of AIDS in The Netherlands and the European Union. The method used has the advantage of being based on a bottom-up approach to resource utilization, involving the use of prospective data for the patients' full lifespans, and can easily be applied to other areas of health services research

What are we preparing them for? Development of an inventory of tasks for medical, surgical and supportive specialties

<p>Background: Internationally, postgraduate medical education (PGME) has shifted to competency-based training. To evaluate the effects of this shift on the outcomes of PGME appropriate instruments are needed.</p><p>Aim: To provide an inventory of tasks specialists perform in practice, which can be used as an instrument to evaluate the outcomes of PGME across disciplines.</p><p>Methods: Following methodology from job analysis in human resource management, we used document analyses, observations, interviews and questionnaires. Two thousand seven hundred and twenty eight specialists were then asked to indicate how frequently they performed each task in the inventory, and to suggest additional tasks. Face and content validity was evaluated using interviews and the questionnaire. Tasks with similar content were combined in a total of 12 clusters. Internal consistency was evaluated by calculating Cronbach's alpha. Construct validity was determined by examining predefined differences in task performance between medical, surgical and supportive disciplines.</p><p>Results: Seven hundred and six specialists (36%) returned the questionnaire. The resulting inventory of 91 tasks showed adequate face and content validity. Internal consistency of clusters of tasks was adequate. Significant differences in task performance between medical, surgical and supportive disciplines indicated construct validity.</p><p>Conclusion: We established a comprehensive, generic and valid inventory of tasks of specialists which appears to be applicable across medical, surgical and supportive disciplines.</p>