Variations in the Care of HIV-Infected Adults in the United States

Shapiro, Martin F.; Morton, Sally C.; McCaffrey, Daniel F.; Senterfitt, J. Walton; Fleishman, John A.; Perlman, Judith F.; Athey, Leslie A.; Keesey, Joan; Goldman, Dana P.; Berry, Sandra H.; Bozzette, Samuel A.

doi:10.1001/jama.281.24.2305

Cited by 656 publications

(143 citation statements)

References 16 publications

(11 reference statements)

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“…For example, HIV-infected women are less likely to be on combination antiretroviral therapy and are more likely than men to have hospitalizations and emergency room visits. 34 Other studies have suggested that healthcare systems are not structured to meet women's healthcare needs: clinics tend to have inconvenient and inflexible hours, long waits, and a lack of staff from the same ethnic or racial groups as most patients. 35 Authors have suggested that cultural values and beliefs, as well as such competing needs as for food, clothing, and shelter, may adversely affect Pap smear screening among women from racial and ethnic minority groups.…”

Section: Discussionmentioning

confidence: 99%

HIV Women's Health: A Study of Gynecological Healthcare Service Utilization in a U.S. Urban Clinic Population

Tello

Yeh

Keller

et al. 2008

Journal of Women's Health

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Background: Women infected with HIV have a high rate of many gynecological problems. Adherence to recommended gynecological care among women enrolled in our urban HIV clinics was hypothesized to be low. Conclusions: This analysis determined that the rate of clinic visit adherence is significantly lower for HIV gynecological care than for HIV primary care in the same population of women. Factors associated with HIV gynecological clinic visit noncompliance included African American race/ethnicity, substance use, and more advanced immunosuppression. We have planned additional quantitative and qualitative studies to examine the associations with and barriers to HIV gynecological care, with the goal of creating appropriate interventions toward improving gynecological healthcare utilization among women enrolled in urban HIV clinics.

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Section: Discussionmentioning

confidence: 99%

HIV Women's Health: A Study of Gynecological Healthcare Service Utilization in a U.S. Urban Clinic Population

Tello

Yeh

Keller

et al. 2008

Journal of Women's Health

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“…[22] In the pre-HAART era, one study using hospital discharge claims data reported that HIV infected individuals with psychiatric illnesses had fewer inpatient medical admissions but had longer lengths of stay, compared to those without psychiatric illness. [23] Those HIV infected individuals diagnosed with SMI were reported to have among the longest hospital stays, even when compared to those with other non-SMI psychiatric illnesses.…”

Section: Introductionmentioning

confidence: 99%

“…It is quite possible that having 3 stigmatizing diseases --HIV, a serious mental illness and injection drug use --may be associated with not only worse access to medical treatment, including access to HAART, but may also be associated with increased HIV-related morbidity as well as increased reliance on costly inpatient hospitalizations. [22] The goal of this study is to determine, among a sample of HIV infected individuals receiving outpatient HIV primary medical care, whether SMI and a history of co-occurring IDU are associated with: (1) decreased receipt of HAART; (2) increased utilization of inpatient general medical hospitalizations and (3) increased median length of inpatient hospitalization as compared to those with SMI alone, IDU alone or those with neither SMI nor IDU. This study improves upon the results of previous studies because analyses adjust for severity of HIV disease (e.g.…”

Section: Introductionmentioning

confidence: 99%

Access to HAART and utilization of inpatient medical hospital services among HIV-infected patients with co-occurring serious mental illness and injection drug use

Himelhoch

Chander

Fleishman

et al. 2007

General Hospital Psychiatry

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Objective-Among HIV infected individuals we examined whether having a co-occurring serious mental illness (SMI) and injection drug use (IDU) impacts: (1) receipt of HAART and (2) utilization of inpatient HIV services, compared to those who have SMI only, IDU only, or neither.Methods-Demographic, clinical, and resource utilization data were collected from medical records of 5,119 patients in HIV primary care at 4 U.S. HIV care sites in different geographic regions with on-site mental health services in 2001. We analyzed receipt of HAART using multivariate logistic regression and number of medical hospital admissions using multivariate logistic and Poisson regression analyses, which controlled for demographic factors, receipt of HAART, CD4 count and HIV-1 RNA. Conclusions-HIV-infected individuals with co-occurring SMI and IDU are significantly more likely to utilize HIV-related medical inpatient services than individuals with no or only one comorbidity. Individuals with both SMI and IDU did not differ from those with IDU only in receipt of HAART. Inpatient hospitalizations are expensive, and efforts should be targeted towards these populations to reduce potentially avoidable inpatient care. Results-

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“…22,23 Patients with co-occurring substance use and HIV use higher levels of emergency room and inpatient services and have longer lengths of inpatient stays than other HIV-infected persons, 24,25 although opioid agonist treatment is associated with reduced acute care utilization. [25][26][27][28][29][30] Yet, people living with HIV and who use injection drugs have been found to receive inadequate medical care, 31,32 largely because medical care and drug treatment are traditionally delivered separately and by different providers. 33 One study of a multi-site sample of HIV patients considered ''hard-to-reach'' found that heavy alcohol use was associated with use of emergency visits.…”

mentioning

confidence: 99%

Patient Perspectives of an Integrated Program of Medical Care and Substance Use Treatment

Drainoni

Farrell²,

Sorensen-Alawad³

et al. 2014

AIDS Patient Care and STDs

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The benefits of integrating primary care and substance use disorder treatment are well known, yet true integration is difficult. We developed and evaluated a team-based model of integrated care within the primary care setting for HIV-infected substance users and substance users at risk for contracting HIV. Qualitative data were gathered via focus groups and satisfaction surveys to assess patients' views of the program, evaluate key elements for success, and provide recommendations for other programs. Key themes related to preferences for the convenience and efficiency of integrated care; support for a team-based model of care; a feeling that the program requirements offered needed structure; the importance of counseling and education; and how provision of concrete services improved overall well-being and quality of life. For patients who received buprenorphine/naloxone for opioid dependence, this was viewed as a major benefit. Our results support other studies that theorize integrated care could be of significant value for hard-to-reach populations and indicate that having a clinical team dedicated to providing substance use disorder treatment, HIV risk reduction, and case management services integrated into primary care clinics has the potential to greatly enhance the ability to serve a challenging population with unmet treatment needs.

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Variations in the Care of HIV-Infected Adults in the United States

Cited by 656 publications

References 16 publications

HIV Women's Health: A Study of Gynecological Healthcare Service Utilization in a U.S. Urban Clinic Population

HIV Women's Health: A Study of Gynecological Healthcare Service Utilization in a U.S. Urban Clinic Population

Access to HAART and utilization of inpatient medical hospital services among HIV-infected patients with co-occurring serious mental illness and injection drug use

Patient Perspectives of an Integrated Program of Medical Care and Substance Use Treatment

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