Metabolic/CVD and Cancer Screening Rates by HIV Care Model.

<p>Metabolic/CVD and Cancer Screening Rates by HIV Care Model.</p

Non-Communicable Disease Preventive Screening by HIV Care Model

<div><p>Importance</p><p>The Human Immunodeficiency Virus (HIV) epidemic has evolved, with an increasing non-communicable disease (NCD) burden emerging and need for long-term management, yet there are limited data to help delineate the optimal care model to screen for NCDs for this patient population.</p><p>Objective</p><p>The primary aim was to compare rates of NCD preventive screening in persons living with HIV/AIDS (PLWHA) by type of HIV care model, focusing on metabolic/cardiovascular disease (CVD) and cancer screening. We hypothesized that primary care models that included generalists would have higher preventive screening rates.</p><p>Design</p><p>Prospective observational cohort study.</p><p>Setting</p><p>Partners HealthCare System (PHS) encompassing Brigham & Women’s Hospital, Massachusetts General Hospital, and affiliated community health centers.</p><p>Participants</p><p>PLWHA age >18 engaged in active primary care at PHS.</p><p>Exposure</p><p>HIV care model categorized as infectious disease (ID) providers only, generalist providers only, or ID plus generalist providers.</p><p>Main Outcome(s) and Measures(s)</p><p>Odds of screening for metabolic/CVD outcomes including hypertension (HTN), obesity, hyperlipidemia (HL), and diabetes (DM) and cancer including colorectal cancer (CRC), cervical cancer, and breast cancer.</p><p>Results</p><p>In a cohort of 1565 PLWHA, distribution by HIV care model was 875 ID (56%), 90 generalists (6%), and 600 ID plus generalists (38%). Patients in the generalist group had lower odds of viral suppression but similar CD4 counts and ART exposure as compared with ID and ID plus generalist groups. In analyses adjusting for sociodemographic and clinical covariates and clustering within provider, there were no significant differences in metabolic/CVD or cancer screening rates among the three HIV care models.</p><p>Conclusions</p><p>There were no notable differences in metabolic/CVD or cancer screening rates by HIV care model after adjusting for sociodemographic and clinical factors. These findings suggest that HIV patients receive similar preventive health care for NCDs independent of HIV care model.</p></div

Odds of non-communicable disease screening events comparing ID plus generalist and generalist groups to ID group.

<p>Panel A shows odds of metabolic/CVD screening. Panel B shows odds of cancer screening rates. Odds ratios and 95% confidence intervals are shown for unadjusted and adjusted analyses.</p

Odds of comparative diabetes screening events by specific screening types (A1C vs. fasting glucose).

<p>Odds ratios and 95% confidence intervals are shown for for unadjusted and adjusted analyses.</p

Cohort Development.

<p>The flowchart indicates specific exclusion criteria applied in a stepwise manner to develop the final cohort for the study.</p

Correlates of Smoking in Overall Group^*.

<p>Correlates of Smoking in Overall Group<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0153103#t003fn001" target="_blank">^*</a>.</p

Patient Characteristics^*.

<p>Patient Characteristics<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0153103#t001fn001" target="_blank">^*</a>.</p

Cohort Demographic and Clinical Characteristics.

<p>Cohort Demographic and Clinical Characteristics.</p

Performance of NLP-based^†† Algorithm by Patient Characteristic.

<p>Performance of NLP-based<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0153103#t002fn004" target="_blank">^††</a> Algorithm by Patient Characteristic.</p

Activity Monitor Intervention to Promote Physical Activity of Physicians-In-Training: Randomized Controlled Trial

<div><p>Background</p><p>Physicians are expected to serve as role models for healthy lifestyles, but long work hours reduce time for healthy behaviors. A hospital-based physical activity intervention could improve physician health and increase counseling about exercise.</p><p>Methods</p><p>We conducted a two-phase intervention among 104 medical residents at a large hospital in Boston, Massachusetts. Phase 1 was a 6-week randomized controlled trial comparing daily steps of residents assigned to an activity monitor displaying feedback about steps and energy consumed (intervention) or to a blinded monitor (control). Phase 2 immediately followed and was a 6-week non-randomized team steps competition in which all participants wore monitors with feedback. Phase 1 outcomes were: 1) median steps/day and 2) proportion of days activity monitor worn. The Phase 2 outcome was mean steps/day on days monitor worn (≥500 steps/day). Physiologic measurements were collected at baseline and study end. Median steps/day were compared using Wilcoxon rank-sum tests. Mean steps were compared using repeated measures regression analyses.</p><p>Results</p><p>In Phase 1, intervention and control groups had similar activity (6369 vs. 6063 steps/day, p = 0.16) and compliance with wearing the monitor (77% vs. 77% of days, p = 0.73). In Phase 2 (team competition), residents recorded more steps/day than during Phase 1 (Control: 7,971 vs. 7,567, p = 0.002; Intervention: 7,832 vs. 7,739, p = 0.13). Mean compliance with wearing the activity monitor decreased for both groups during Phase 2 compared to Phase 1 (60% vs. 77%, p<0.001). Mean systolic blood pressure decreased (p = 0.004) and HDL cholesterol increased (p<0.001) among all participants at end of study compared to baseline.</p><p>Conclusions</p><p>Although the activity monitor intervention did not have a major impact on activity or health, the high participation rates of busy residents and modest changes in steps, blood pressure, and HDL suggest that more intensive hospital-based wellness programs have potential for promoting healthier lifestyles among physicians.</p><p>Trial Registration</p><p>Clinicaltrials.gov <a href="http://clinicaltrial.gov/ct2/show/NCT01287208?term=NCT01287208&rank=1" target="_blank">NCT01287208</a>.</p></div