[Management and follow-up of patients treated with antiretroviral prophylaxis: an evaluation of professional practices].
The care management of patients treated for cases of sexual or blood exposure requires stringent clinical and biological follow-up procedures. Despite the provision of information about the importance of regular follow-up, the number of patients dropping out of screening consultations at the Hospital Lariboisière-Fernand Widal (Assistance Publique-Hôpitaux de Paris) has increased. The main purpose of this study is to improve follow-up for patients treated with anti-retroviral prophylaxis following a known sexual or blood exposure. An investigation based on 5 markers of a targeted clinical audit form ("drop-outs" or lost to follow-up, conduct of HIV serology tests, traceability of clinical, biological and compliance monitoring) was carried out. A review of practices was conducted on the basis of an analysis of patient cases over a six-month period, followed by the implementation and evaluation of corrective measures over a two-year period. A significant decline in the number of patients lost to follow-up was observed. The study shows a significant improvement in other markers: serological follow-up, compliance traceability, and clinical and biological monitoring. These results were observed between 2005 and 2007. Two distinctive effects were identified: improvement in patient care management and the quality of care, and the empowerment of actors, thereby ensuring a certain continuity of action. The decline in the rate of lost to follow-up patients and improved monitoring of compliance and iatrogenic risks confirm these effects. The overall approach is incorporated into an evaluation of professional practices.
Le Divenah
Aude
A
Service de Santé Publique et d'économie de la santé, CHU Lariboisière-F, Widal, AP-HP,2,rue Amboiseparé, Paris cedex, France.
David
Stéphane
S
Brignone
Mélanie
M
Chau
Ingrid
I
Segouin
Christophe
C
Kauffmann
Clarisse
C
Benabdelmoumen
Ghania
G
Shelly
Marc
M
Régnier
Christian
C
Sellier
Pierre
P
Bertrand
Dominique
D
D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D054869:Clinical Audit; D005500:Follow-Up Studies; D005602:France; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D055118:Medication Adherence; D010352:Patient Dropouts; D011785:Quality Assurance, Health Care
D044966:Anti-Retroviral Agents