Hospital and Outpatient Health Services Utilization Among HIV-Infected Adults in Care 2000???2002

The Children's Hospital of Philadelphia, Filadelfia, Pennsylvania, United States
Medical Care (Impact Factor: 3.23). 10/2005; 43(9 Suppl):III40-52. DOI: 10.1097/01.mlr.0000175621.65005.c6
Source: PubMed


Rapid changes in HIV epidemiology and antiretroviral therapy may have resulted in recent changes in patterns of healthcare utilization.
The objective of this study was to examine sociodemographic and clinical correlates of inpatient and outpatient HIV-related health service utilization in a multistate sample of patients with HIV.
Demographic, clinical, and resource utilization data were collected from medical records for 2000, 2001, and 2002.
This study was conducted at 11 U.S. HIV primary and specialty care sites in different geographic regions.
In each year, HIV-positive patients with at least one CD4 count and any use of inpatient, outpatient, or emergency room services. Sample sizes were 13,392 in 2000, 15,211 in 2001, and 14,403 in 2002.
Main outcome measures were number of hospital admissions, total days in hospital, and number of outpatient clinic/office visits per year. Inpatient and outpatient costs were estimated by applying unit costs to numbers of inpatient days and outpatient visits.
Mean numbers of admissions per person per year decreased from 2000 (0.40) to 2002 (0.35), but this difference was not significant in multivariate analyses. Hospitalization rates were significantly higher among patients with greater immunosuppression, women, blacks, patients who acquired HIV through drug use, those 50 years of age and over, and those with Medicaid or Medicare. Mean annual outpatient visits decreased significantly between 2000 and 2002, from 6.06 to 5.66 visits per person per year. Whites, Hispanics, those 30 years of age and over, those on highly active antiretroviral therapy (HAART), and those with Medicaid or Medicare had significantly higher outpatient utilization. Inpatient costs per patient per month (PPPM) were estimated to be 514 dollars in 2000, 472 dollars in 2001, and 424 dollars in 2002; outpatient costs PPPM were estimated at 108 dollars in 2000, 100 dollars in 2001, and 101 dollars in 2002.
Changes in utilization over this 3-year period, although statistically significant in some cases, were not substantial. Hospitalization rates remain relatively high among minority or disadvantaged groups, suggesting persistent disparities in care. Combined inpatient and outpatient costs for patients on HAART were not significantly lower than for patients not on HAART.

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    • "Studies done earlier in this century have shown some disparity in the hospitalization rates which was higher among the minority or disadvantage group giving clues to existing inequalities in care while inpatient utilization in children showed some dissimilarities to adults compared with previous studies as well as less pronounced racial/ethnic or gender disparities in healthcare utilization for HIV-infected children unlike adults [9] [10] Research has also suggested that though opportunistic infection have declined with the introduction of HAARTS, there is an upsurge of decompensate liver disease and increase in admission rates of HIV/HCV co-infected patients and IDU meaning worsened hospitalization rates for liver related complications [8] [11] [12] [13] In a country based qualitative study done in rural Kinesa district Tanzania which explored perception of and experience of barrier to accessing the national ARV programme among self-identified HIV-positive persons showed that most patients were willing to join a support group while some changed attitude to disclosure, both experienced and anticipated discrimination persisted to hinder wide spread use of ART and simple measures reduced perceived barrier initially while passive stigma remained a problem [14] Many other studies have demonstrated changes in trend and pattern of HIV patient admission in the hospital and also in different sections of health facilities, a decline in ADI associated with patient admission and possible effects on utilization of care [15] [16] [17] [18] [19] It is also noted that partnership is increasing in African region in order to raise awareness of HIV/AIDs. A Nigerian Survey revealed a National prevalence of 4.1%, this ranged between 1.0% in Kebbi State to 12.7% in Benue State with Abia state having 7.0 prevalence rate. "

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    • "The majority of charges for health services among individuals infected with HIV/AIDS come from public sources such as Medicaid, Ryan White, and Medicare, making it imperative for those who allocate health care dollars for HIV treatment to be aware of the cost of treating people with HIV/AIDS [6]. In 1996, combination antiretroviral drug therapy became more common[7]. The average annual number of admissions and charges for inpatient and overall HIV/AIDS care decreased between 1996–2000 [8,9]. "
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    ABSTRACT: Inpatient HIV/AIDS charges decreased from 1996-2000. This decrease was mainly attributable to treatment of HIV/AIDS patients with Highly Active Antiretroviral Therapy (HAART). This study aims to evaluate the trend in inpatient charges from 2000-2004. Rhode Island Hospital Discharge Data (HDD) from 2000 to 2004 was used. International Classification of Disease (ICD-9) diagnosis code 042-044 was used to identify HIV/AIDS admissions. The final study population included 1927 HIV/AIDS discharges. We used a multivariable linear regression model to examine the factors associated with inflation adjusted inpatient charges. We found a significant increase in inpatient charges from 2000-2004 after adjusting for length of stay (LOS), gender, age, race and point of entry for hospitalization. In addition to calendar year, LOS, gender and race were also associated with inpatient charges. HIV/AIDS inpatient charges increased after adjusting for inflation despite earlier studies that showed a decline. Our results have implications for uninsured, as well as insured HIV/AIDS patients who do not have a medical plan that covers their charges sufficiently. Future research should investigate what factors are contributing to rising inpatient charges among HIV/AIDS patients.
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    • "Specifically related to HIV, previous studies evaluating outpatient and inpatient utilization in the HIV-positive adult population have found that demographic and HIV-specific factors are associated with increased requirements of inpatient resources. Fleishman et al. found that black patients, female patients, and those with worsening immunosuppression, as determined by either CD4 count or viral load, were more likely to require inpatient care in the HAART era [21]. Floris-Moore et al. found that female sex and not being on HAART increased the risk of hospitalization among HIV-positive adults [22]. "
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