Larger is not necessarily better! Impact of HIV care unit characteristics on virological success: results from the French national representative ANRS-VESPA2 study

Luis Sagaon-Teyssier 1, 2, * Lisa Fressard 1, 2 Marion Mora 1, 2 Gwenaelle Maradan 1, 2 Valérie Guagliardo 1, 2 Marie Suzan-Monti 1, 2 Rosemary Dray-Spira 3 Bruno Spire 1, 2, *
* Corresponding author
1 SESSTIM - U912 INSERM - Aix Marseille Univ - IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
2 ORS PACA - Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille]
3 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
Abstract : OBJECTIVES: To determine the impact of hospital caseload size on HIV virological success when taking into account individual patient characteristics. METHODS: Data from the ANRS-VESPA2 survey representative of people living with HIV in France was used. Analyses were carried out on the 2612 (86.4% out of 3022) individuals receiving antiretroviral (ARV) treatment for at least one year. Outcomes correspond to two definitions of virological success (VS1 and VS2 respectively) and were analyzed under a multi-level modeling framework with a special focus on the effect of the caseload size on VS. RESULTS: Structures with caseloads <1700 patients were more likely to have increased the proportion of patients achieving virological success (59% and 81% for VS1 and VS2, respectively) than structures whose caseloads numbered ≥1700 patients. Our results highlight that patients in the 11 largest care units in the sample were exposed to a context where their VS was potentially compromised by care unit characteristics, independently of both their individual characteristics and their own HIV treatment adherence behavior. CONCLUSIONS: Our results suggest that - at least in the case of HIV care - in France large care units are not necessarily better. This result serves as an evidence-based warning to public authorities to ensure that health outcomes are guaranteed in an era when the French hospital sector is being substantially restructured.
Keywords : multi-level modeling caseload size HIV clinical outcomes Hospital merger
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Journal articles
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https://www.hal.inserm.fr/inserm-01994711
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Submitted on : Friday, January 25, 2019 - 4:16:59 PM
Last modification on : Wednesday, March 27, 2019 - 1:33:44 AM

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UNIV-AMU | U1252 | SORBONNE-UNIVERSITE | IPLESP | SU-MEDECINE

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Luis Sagaon-Teyssier, Lisa Fressard, Marion Mora, Gwenaelle Maradan, Valérie Guagliardo, et al.. Larger is not necessarily better! Impact of HIV care unit characteristics on virological success: results from the French national representative ANRS-VESPA2 study. Health Policy, Elsevier, 2016, 120 (8), pp.936-947. ⟨10.1016/j.healthpol.2016.07.003 ⟩. ⟨inserm-01994711⟩

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