Predictors of medical service utilization among individuals with co-occurring HIV infection and substance abuse disorders

Abstract

This study examined factors affecting medical service use among HIV-infected persons with a substance abuse disorder. The sample comprised 190 participants enrolled in a randomized trial of a case management intervention. Participants were interviewed about their backgrounds, housing status, income, alcohol and drug use problems, health status and depressive symptoms at study entry. Electronic medical records were used to assess medical service use. Poisson regression models were tested to determine the effects of need, enabling and predisposing factors on the dependent variables of emergency department visits, inpatient admissions and ambulatory care visits. During a two-year period, 71% were treated in the emergency department, 64% had been hospitalized and the sample averaged 12.9 ambulatory care visits. Homelessness was associated with higher utilization of emergency department and inpatient services; drug use severity was associated with higher inpatient and ambulatory care service use; and alcohol use severity was associated with greater use of emergency medical services. Homelessness and substance abuse exacerbate the health care needs of HIV-infected persons and result in increased use of emergency department and inpatient services. Interventions are needed that target HIV-infected persons with substance abuse disorders, particularly those that increase entry and retention in outpatient health care and thus decrease reliance on acute hospital-based services.

Medicaid Patients at High Risk for Frequent Hospital Admission: Real-Time Identification and Remediable Risks

“…Patients and caregivers cited these factors as contributing substantially to their hospital admissions, consistent with other reports. 8 Much of the literature examining characteristics of patients with frequent hospital admissions has substantial limitations, which our study sought to overcome. Some studies are focused on patients with specific conditions, limiting the generalizability of potential interventions.…”

“…7 The majority of studies examining risk factors associated with frequent hospital admissions focus only on patients with specific diagnoses such as HIV, congestive heart failure or psychiatric disease, or in specific age ranges such as infants or the elderly. [8][9][10] This limits the ability of policy makers and providers to determine whether unifying factors that could be targeted for intervention exist amongst a more general population of patients with frequent hospital admissions.…”

Behavior Change and Health-Related Interventions for Heterosexual Risk Reduction Among Drug Users

“…Although HIV counseling and testing and prevention and treatment of STDs have been implemented in several resource-rich and resource-constrained countries and have been associated with various levels of success, only a small proportion of IDUs in resourcerich and resource-constrained countries have received HAART for HIV. Issues related to cost and availability of a well-developed infrastructure affect this limited access (Dawson-Rose et al, 2005;Ksobiech and Malow, 2005;Masson et al, 2004;Sterk et al, 2002).…”

Alcohol Use, Depressive Symptoms and the Receipt of Antiretroviral Therapy in Southwest Uganda

“…Alcohol use is associated with inefficient patterns of health care utilization, including lower rates of outpatient service use (Alexandre et al 2001;Cunningham 2006;Masson et al 2004). Alcohol consumption was identified as an important barrier to treatment uptake among marginalized Aboriginal people living with HIV in Western Australia (Newman et al 2007).…”