Healthcare utilization of patients accessing an African national treatment program

 

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dc.contributor.author Harling, Guy en_ZA
dc.contributor.author Orrell, Catherine en_ZA
dc.contributor.author Wood, Robin en_ZA
dc.date.accessioned 2015-10-12T10:51:38Z
dc.date.available 2015-10-12T10:51:38Z
dc.date.issued 2007 en_ZA
dc.identifier.citation Harling, G., Orrell, C., & Wood, R. (2007). Healthcare utilization of patients accessing an African national treatment program. BMC health services research, 7(1), 80. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/14166
dc.identifier.uri http://dx.doi.org/10.1186/1472-6963-7-80
dc.description.abstract BACKGROUND:The roll-out of antiretroviral therapy (ART) in Africa will have significant resource implications arising from its impact on demand for healthcare services. Existing studies of healthcare utilization on HAART have been conducted in the developed world, where HAART is commenced when HIV illness is less advanced. METHODS: This paper describes healthcare utilization from program entry by treatment-naive patients in a peri-urban settlement in South Africa. Treatment criteria included a CD4 cell count <200 cells/mul or an AIDS-defining illness. Data on health service utilization were collected retrospectively from the primary-care clinic and secondary and tertiary referral hospitals. Hospital visits were reviewed to determine the clinical reason for each visit. RESULTS: 212 patients were followed for a median of 490 days. Outpatient visits per 100 patient years of observation (PYO), excluding scheduled primary-care follow-up, fell from 596 immediately prior to ART to 334 in the first 48 weeks on therapy and 245 thereafter. Total inpatient time fell from 2,549 days per 100 PYO pre-ART to 476 in the first 48 weeks on therapy and 73 thereafter. This fall in healthcare utilization occurred at every level of care. The greatest causes of utilization were tuberculosis, cryptococcal meningitis, HIV-related neoplasms and adverse reactions to stavudine. After 48 weeks on ART demand reverted to primarily non-HIV-related causes. CONCLUSION: Utilization of both inpatient and outpatient hospital services fell significantly after commencement of ART for South African patients in the public sector, with inpatient demand falling fastest. Earlier initiation might reduce early on-ART utilization rates. en_ZA
dc.language.iso eng en_ZA
dc.publisher Biomed Central Ltd en_ZA
dc.rights This is an Open Access article distributed under the terms of the Creative Commons Attribution License en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/2.0 en_ZA
dc.source BMC Health Services Research en_ZA
dc.source.uri http://www.biomedcentral.com/bmchealthservres/ en_ZA
dc.subject.other Health care utilization en_ZA
dc.title Healthcare utilization of patients accessing an African national treatment program en_ZA
dc.type Journal Article en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Desmond Tutu HIV Centre en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Harling, G., Orrell, C., & Wood, R. (2007). Healthcare utilization of patients accessing an African national treatment program. <i>BMC Health Services Research</i>, http://hdl.handle.net/11427/14166 en_ZA
dc.identifier.chicagocitation Harling, Guy, Catherine Orrell, and Robin Wood "Healthcare utilization of patients accessing an African national treatment program." <i>BMC Health Services Research</i> (2007) http://hdl.handle.net/11427/14166 en_ZA
dc.identifier.vancouvercitation Harling G, Orrell C, Wood R. Healthcare utilization of patients accessing an African national treatment program. BMC Health Services Research. 2007; http://hdl.handle.net/11427/14166. en_ZA
dc.identifier.ris TY - Journal Article AU - Harling, Guy AU - Orrell, Catherine AU - Wood, Robin AB - BACKGROUND:The roll-out of antiretroviral therapy (ART) in Africa will have significant resource implications arising from its impact on demand for healthcare services. Existing studies of healthcare utilization on HAART have been conducted in the developed world, where HAART is commenced when HIV illness is less advanced. METHODS: This paper describes healthcare utilization from program entry by treatment-naive patients in a peri-urban settlement in South Africa. Treatment criteria included a CD4 cell count <200 cells/mul or an AIDS-defining illness. Data on health service utilization were collected retrospectively from the primary-care clinic and secondary and tertiary referral hospitals. Hospital visits were reviewed to determine the clinical reason for each visit. RESULTS: 212 patients were followed for a median of 490 days. Outpatient visits per 100 patient years of observation (PYO), excluding scheduled primary-care follow-up, fell from 596 immediately prior to ART to 334 in the first 48 weeks on therapy and 245 thereafter. Total inpatient time fell from 2,549 days per 100 PYO pre-ART to 476 in the first 48 weeks on therapy and 73 thereafter. This fall in healthcare utilization occurred at every level of care. The greatest causes of utilization were tuberculosis, cryptococcal meningitis, HIV-related neoplasms and adverse reactions to stavudine. After 48 weeks on ART demand reverted to primarily non-HIV-related causes. CONCLUSION: Utilization of both inpatient and outpatient hospital services fell significantly after commencement of ART for South African patients in the public sector, with inpatient demand falling fastest. Earlier initiation might reduce early on-ART utilization rates. DA - 2007 DB - OpenUCT DO - 10.1186/1472-6963-7-80 DP - University of Cape Town J1 - BMC Health Services Research LK - https://open.uct.ac.za PB - University of Cape Town PY - 2007 T1 - Healthcare utilization of patients accessing an African national treatment program TI - Healthcare utilization of patients accessing an African national treatment program UR - http://hdl.handle.net/11427/14166 ER - en_ZA


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