| ObjectiveBased on the understanding of the current situation of the free ART in three cities and two counties of Yunnan province, we investigated in these places’different medical institutions the healthcare worker configuration and their out-patient time spent on AIDS patients and patients with chronic hepatitis. Setting out-patient time of patients with chronic hepatitis as contrast, we compared the out-patient time of AIDS and chronic hepatitis patients; further, we explored the factors which influenced the out-patient time of retreated patients; in order to provide suggestions in how to improve free ART work through better human resources and time input.MethodsA cross-sectional study was done to get knowledge of the number of ART medical staff, out-patient treatment process and time-consuming of AIDS patients and chronic hepatitis patients in six hospitals of three cities and two counties of Yunnan province. Qualitative studyAccording to principles of information saturation, personal in-depth interviews with30outpatients being treated were conducted to understand their experience as outpatient, willingness to be treated, depth and time communicating with doctors in treatment processes, and treatment satisfaction. The qualitative study results, combined with quantitative data, were analyzed to get knowledge of outpatients’ attitude and need to free ART and factors impacting on their out-patient treating time. Contents of personal in-depth interview were analyzed with Nvivo8.0. Quantitative studySome places in which AIDS epidemic was comparatively serious were selected in Yunnan province, which were Kunming City, Baoshan City, Honghe Prefecture, Tengchong County and Jianshui County. According to the principles of typical study, we selected medical institutions of different levels, where were two provincial or municipal hospitals in the capital city, two municipal hospital in other cities, and two county hospitals. Each medical institution had been surveyed for two weeks, and the survey time was allocated in proportion of4:3. All AIDS patients in the medical institutions during the survey period, first-time treated or retreated, were surveyed through face to face quantitative interviews. Setting chronic hepatitis patients as contrast, AIDS patients’treating time and the number of ART medical staff were recorded and counted. Epidata Software was used to double enter and clean the data. Data analyses were performed using SAS9.2. Constituent ratio was compared using Fisher’s exact test, two sets of time median were compared using Wilcoxon Two-Sample Test, multiple sets of time median were compared using Kruskal-Wallis Test, the comparison between two sets of time median among multiple sets of time median were using LSD-t Test for r, factors influencing treating time of retreated AIDS outpatients were analyzed using General Linear Models.ResultThe quantitative study covered514AIDS outpatients,111chronic hepatitis outpatients,42ART medical staffs,35medical staffs treating chronic hepatitis. The qualitative study covered30AIDS outpatients.1. The number of ART medical staffs in the six hospitals of Yunnan province:the number is42. ART related work was undertaken by the ART outpatient in AIDS care center and by the infection department in the other5hospitals.2. The outpatient treatment processes:the main processes of the two patients were similar, including registration, open a single laboratory, blood, prescription and dispensary.3. Treating time comparison of AIDS outpatients and chronic hepatitis outpatients: Treating time median of16first-time referral AIDS outpatients was33.2minutes (IQR22.3-42.6), and treating time median of29first-time treated AIDS outpatients was32.8minutes (IQR26.0-42.4). The difference of the two treating time was not statistically significant (Wilcoxon Two-Sample Test Z=0.4861, P=0.6269). Treating time median of16first-time treated chronic hepatitis outpatients was9.6minutes (IQR8.7-11.5). The treating time difference between first-time treated chronic hepatitis outpatients and first-time referral or treated AIDS outpatients were both statistically significant (Wilcoxon Two-Sample Test Z=4.7304, P<0.0001;Z=5.4891, P0.0001). The treating time of first-time referral and treated AIDS outpatients were both longer than that of first-time treated chronic hepatitis outpatients.Treating time median of469retreated AIDS outpatients was10.6minutes (IQR9.1-12.9), and treating time median of95retreated chronic hepatitis outpatients was6.6minutes (IQR5.1-8.5). Treating time of retreated AIDS outpatients was longer than retreated chronic hepatitis outpatients (Wilcoxon Two-Sample Test Z=11.4950, P0.0001)4. Factors impacting on retreated AIDS outpatients:The result of univariate analysis of Wilcoxon test showed age, ethnic, marital status, treatment programs, whether or not side effects existed and the range of hospital was statistically correlated with treatment time respectively (P<0.05). Multivariate analysis result showed14years old younger (F=26.28, P<0.0001), the use of second-line treatment program (F=105.58, p<0.0001) and side effects (F=79.14, P<0.0001) made outpatients’ treatment time longer meanwhile the county hospital made outpatients’treatment time shorter(F=11.16, p<0.0001).5. Compared with the patients with chronic hepatitis, AIDS patients are more worried about discrimination (Χ2=32.9802, P<0.0001), and suffer greater psychological pressure, they also reflect more need for counseling (x2=31.5077, P<0.0001)6. Only31.3%of the AIDS patients reflect that they hope the hospital could supply free breakfast after the blood test;71.6%of the AIDS patients hope the hospital could provide some travel expenses due to poverty and long distance. Conclusion1. The quality and integrated level of the ART medical personnel for AIDS was lower than that of the medical personnel for chronic hepatitis.2. AIDS and chronic hepatitis are similar in pathogens, mode of transmission and course. However, treatment time of either first-time treated or retreated AIDS patients was longer than first-time treated or retreated chronic hepatitis patients; which showed that medical staffs consumed more time and energy on AIDS outpatients.3. Among retreated AIDS outpatients, who come to the county hospital will use less time which might related to the lack of staff and the simpler treatment process; treatment time of pediatric patients younger than14years old, patients using second-line treatment program and patients which had side effects in recent one month were longer, which might correlated with the patients’ adherence.4. To provide free breakfast or not after the blood test might be depending on the specific circumstances, howerer, supplying some travel expenses for the poor patients is a good policy.5. It’s the first study in China about treatment time medical staffs spent on AIDS and chronic hepatitis patients. It is of significant reference and practical value for medical institutions’human resources and time input on AIDS patients, especially in the situation that ART is becoming more and more standardized and the number of ART patients is getting bigger and bigger. |
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