title: Hospital and ambulatory management, and compliance to treatment in HIV infection: regional health insurance agency analysis.
abstract: OBJECTIVE
  We had for objective to study HIV management (hospital, ambulatory, and mixed) and assess compliance with health insurance database.
  
  
  METHODS
  We conducted a retrospective study using the French Social Security (CPAM) database. The inclusion criteria were: age>18years of age, at least 2 prescriptions of antiretroviral therapy.
  
  
  RESULTS
  Five hundred and seventy-five patients were included: extra-hospital (12), hospital (162), mixed (401). The prescriptions were exclusively hospital issued for 76.2% of the patients. Among the mixed group patients, 91% of treatments were delivered at least once in the community, and 45.6% of biological tests were performed in private laboratories at least once. The sex ratio (2.1 vs. 1.3), the number of patients having switched antiretroviral therapy (36.7% vs. 27.8%), and the frequency of biological tests (3.1 vs. 2.6) were significantly higher in the mixed group compared to the hospital group. The mean compliance was 90% in the hospital group and 91.8% in the mixed group. The compliance was<80% for 104 patients (21.8%). Patients with≥80% compliance were older (46.1years of age vs. 42.7years of age), with more frequent biological tests (3 per year vs. 2.5 per year), and more frequent switches in treatment (35.4% vs. 26.0%).
  
  
  CONCLUSIONS
  Prescriptions of ARV were almost exclusively hospital issued. Their dispensation and biological tests were split between hospital and extra-hospital settings. Most patients demonstrated an optimal compliance. The CPAM database allows describing HIV management and assessing compliance.
authors.affiliation: Service d'information médicale, épidémiologie et économie de la santé, université François-Rabelais, CHRU de Tours, 37000 Tours, France; Équipe émergente de recherche éducation, éthique, santé, unité régionale d'épidémiologie hospitalière (UREH), université François-Rabelais, 37000 Tours, France.
authors.forename: C
authors.initials: C
authors.lastname: Hassen-Khodja
authors.affiliation: Service de médecine interne et maladies infectieuses, université François-Rabelais, CHRU de Tours, 37000 Tours, France. Electronic address: g.gras@chu-tours.fr.
authors.forename: G
authors.initials: G
authors.lastname: Gras
authors.affiliation: Service d'information médicale, épidémiologie et économie de la santé, université François-Rabelais, CHRU de Tours, 37000 Tours, France; Équipe émergente de recherche éducation, éthique, santé, unité régionale d'épidémiologie hospitalière (UREH), université François-Rabelais, 37000 Tours, France.
authors.forename: L
authors.initials: L
authors.lastname: Grammatico-Guillon
authors.affiliation: Service médical de la caisse primaire d'assurance maladie, 37000 Tours, France.
authors.forename: C
authors.initials: C
authors.lastname: Dupuy
authors.affiliation: Service médical de la caisse primaire d'assurance maladie, 37000 Tours, France.
authors.forename: J-F
authors.initials: JF
authors.lastname: Gomez
authors.affiliation: Service médical de la caisse primaire d'assurance maladie, 37000 Tours, France.
authors.forename: L
authors.initials: L
authors.lastname: Freslon
authors.affiliation: Réseau ville, hôpital VIH 37, 37000 Tours, France.
authors.forename: J-F
authors.initials: JF
authors.lastname: Dailloux
authors.affiliation: Réseau ville, hôpital VIH 37, 37000 Tours, France.
authors.forename: A
authors.initials: A
authors.lastname: Soufflet
authors.affiliation: Service de médecine interne et maladies infectieuses, université François-Rabelais, CHRU de Tours, 37000 Tours, France.
authors.forename: L
authors.initials: L
authors.lastname: Bernard
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D019380:Anti-HIV Agents / Q000627:therapeutic use; D019468:Disease Management; D005260:Female; D005602:France / Q000453:epidemiology; D006678:HIV; D015658:HIV Infections / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral; Antirétroviraux; Assurance maladie; Compliance; HIV; Health insurance; Observance; VIH