Emergency department utilization among HIV‐infected patients in a multisite multistate study^*

Abstract

Objective-The aim of this study was to examine Emergency Department (ED) utilization and clinical and sociodemographic correlates of ED use among HIV-infected patients.Methods-During 2003, 951 patients participated in face-to-face interviews at 14 HIV clinics in the HIV Research Network. Respondents reported the number of ED visits in the preceding 6 months. Using logistic regression, we identified factors associated with visiting the ED in the last 6 months and admission to the hospital from the ED.Results-Thirty-two per cent of respondents reported at least one ED visit in the last 6 months. In multivariate analysis, any ED use was associated with Medicaid insurance, high levels of pain (the third or fourth quartile), more than seven primary care visits in the last 6 months, current or former illicit drug use, social alcohol use and female gender.Of those who used ED services, 39% reported at least one admission to the hospital. Patients with pain in the highest quartile reported increased admission rates from the ED as did those who made six or seven primary care visits, or more than seven primary care visits vs. three or fewer.Conclusions-The likelihood of visiting the ED has not diminished since the advent of highly active antiretroviraltherapy (HAART). More ED visits are to treat illnesses not related to HIV or injuries than to treat direct sequelae of HIV infection. With the growing prevalence of people living with HIV infection,the numbers of HIV-infected patients visiting the ED may increase, and ED providers need to understand potential complications produced by HIV disease.

Substance Abuse, Violence, and HIV in Women: A Literature Review of the Syndemic

“…56 ED use correlates with high primary care clinic use, current or former illicit drug use, Medicaid enrollment, and female gender, but not with any biologic markers of HIV severity. 56 If this pattern of frequent healthcare utilization is not driven by health issues themselves, there are likely other contributing factors external to the actual ED visit. Given the impact of violence on mental health, substance abuse, and risk taking already discussed, this health-seeking behavior may, in part, also be influenced by experiences of violence.…”

Emergency department use by people with HIV in Ontario: a population-based cohort study

“…Yet, in contrast to studies examining inpatient and out patient health care use, [2][3][4][5][6] comparatively few contemporary studies exist examining emergency department use among people with HIV. [7][8][9][10][11] Studies conducted in the years pre ceding the introduction of combination antiretroviral ther apy demonstrated that people with HIV had rates of emer gency department visits that were three to fourfold higher than those of the general population. 12,13 Although subse quent studies found persistently heightened rates of emer gency department use following the introduction of com bination antiretroviral therapy, inferences were limited by samples that were small and not populationbased.…”

“…12,13 Although subse quent studies found persistently heightened rates of emer gency department use following the introduction of com bination antiretroviral therapy, inferences were limited by samples that were small and not populationbased. 7,9,10 A recent analysis of the US National Hospital Ambulatory Medical Survey demonstrated that rates of emergency department visits among people with HIV continue to exceed those of noninfected people (633 v. 438 visits per 1000 people), although by a smaller magnitude than during the preceding decade. 14 Analogous populationbased studies characterizing emer gency department use among people with HIV in a Canadian setting are lacking.…”

Changes in the etiology, incidence and prognosis of acute lower respiratory track infections in human immunodeficiency virus patients

“…Nowadays, as discussed above, HIV patients come to the ED more often due to pathologies that are not directly associated with HIV. This will continue to be the trend in patients with good immunological control, which, in turn, will entail longer hospital stays and higher utilization of health resources, 10,11,33 with the aim of reducing their morbimortality and related healthcare costs. 34 Finally, our study shows a decrease in the incidence of LRTI and associated mortality, even though it has not remained significant (14%) in the last ten years.…”

“…The changing situation of HIV patients in the HAART era has led to changes in the reasons to seek emergency care along the years. 11 However, these changes may not be well understood. We have been prospectively collecting data on ED admissions at Hospital Clinic, a major hospital located in the center of Barcelona delivering emergency care for a wide urban area.…”