The development of an HIV-specific complexity rating scale

Bulsara, SM; Begley, K; Smith, DE; Chan, DJ; Furner, V; Coote, KV; Hennessy, RM; Alperstein, DM; Price, A; Smith, M; Wyson, A; Wand, H

The development of an HIV-specific complexity rating scale

Bulsara, SM

Begley, K Smith, DE Chan, DJ Furner, V Coote, KV Hennessy, RM Alperstein, DM Price, A Smith, M Wyson, A Wand, H

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Publication Type:: Journal Article
Citation:: International Journal of STD and AIDS, 2019, 30 (13), pp. 1265 - 1274
Issue Date:: 2019-11-01

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Field	Value	Language
dc.contributor.author	Bulsara, SM https://orcid.org/0000-0002-2015-853X	en_US
dc.contributor.author	Begley, K	en_US
dc.contributor.author	Smith, DE	en_US
dc.contributor.author	Chan, DJ	en_US
dc.contributor.author	Furner, V	en_US
dc.contributor.author	Coote, KV	en_US
dc.contributor.author	Hennessy, RM	en_US
dc.contributor.author	Alperstein, DM	en_US
dc.contributor.author	Price, A	en_US
dc.contributor.author	Smith, M	en_US
dc.contributor.author	Wyson, A	en_US
dc.contributor.author	Wand, H	en_US
dc.date.issued	2019-11-01	en_US
dc.identifier.citation	International Journal of STD and AIDS, 2019, 30 (13), pp. 1265 - 1274	en_US
dc.identifier.issn	0956-4624	en_US
dc.identifier.uri	http://hdl.handle.net/10453/139280
dc.description.abstract	© The Author(s) 2019. As treatment for HIV improves, an ageing population is experiencing comorbidity which often leads to complex clinical presentations requiring an interdisciplinary care approach. This study sought to quantify clinician assessment of the level of clinical complexity, through the development of a rating scale for people living with HIV (PLHIV), to improve client care through an interdisciplinary care model. An existing alcohol and other drug complexity rating scale was selected and modified for use with PLHIV. HIV-specific items were included through consultation with an interdisciplinary team. A risk-prediction model was developed and validated using clinician ratings of clients attending The Albion Centre, a tertiary HIV clinic in Sydney, Australia, resulting in the development of the Clinical Complexity Rating Scale for HIV (CCRS-HIV). Multivariable logistic regression models identified eight characteristics based on clinician assessment of complexity in PLHIV: financial instability, social isolation, problematic crystal methamphetamine use, mental illness and/or other problematic substance use, cognitive/neurological impairment, polypharmacy, current hepatitis C infection and/or cancer, and other physical health comorbidity. A weighted risk-prediction model was developed and validated. The final model accurately predicted 85% of complex clients, with a sensitivity of 80% and specificity of 91%. This study developed an HIV-specific clinician-rated complexity scale. Further investigations are required to validate the CCRS-HIV with broader HIV populations. This simple complexity screening tool is a promising adjunct to clinical assessment to identify clients with complex physical and psychosocial needs who may benefit from interdisciplinary care interventions and allocation of resources.	en_US
dc.relation.ispartof	International Journal of STD and AIDS	en_US
dc.relation.isbasedon	10.1177/0956462419868359	en_US
dc.subject.classification	Public Health	en_US
dc.title	The development of an HIV-specific complexity rating scale	en_US
dc.type	Journal Article
utslib.citation.volume	13	en_US
utslib.citation.volume	30	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1108 Medical Microbiology	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Graduate School of Health
utslib.copyright.status	open_access
pubs.issue	13	en_US
pubs.publication-status	Published	en_US
pubs.volume	30	en_US

Abstract:

© The Author(s) 2019. As treatment for HIV improves, an ageing population is experiencing comorbidity which often leads to complex clinical presentations requiring an interdisciplinary care approach. This study sought to quantify clinician assessment of the level of clinical complexity, through the development of a rating scale for people living with HIV (PLHIV), to improve client care through an interdisciplinary care model. An existing alcohol and other drug complexity rating scale was selected and modified for use with PLHIV. HIV-specific items were included through consultation with an interdisciplinary team. A risk-prediction model was developed and validated using clinician ratings of clients attending The Albion Centre, a tertiary HIV clinic in Sydney, Australia, resulting in the development of the Clinical Complexity Rating Scale for HIV (CCRS-HIV). Multivariable logistic regression models identified eight characteristics based on clinician assessment of complexity in PLHIV: financial instability, social isolation, problematic crystal methamphetamine use, mental illness and/or other problematic substance use, cognitive/neurological impairment, polypharmacy, current hepatitis C infection and/or cancer, and other physical health comorbidity. A weighted risk-prediction model was developed and validated. The final model accurately predicted 85% of complex clients, with a sensitivity of 80% and specificity of 91%. This study developed an HIV-specific clinician-rated complexity scale. Further investigations are required to validate the CCRS-HIV with broader HIV populations. This simple complexity screening tool is a promising adjunct to clinical assessment to identify clients with complex physical and psychosocial needs who may benefit from interdisciplinary care interventions and allocation of resources.

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http://hdl.handle.net/10453/139280