Hospital and hospice resource use of HIV-positive patients in Edinburgh

Abstract

A prospective study of health service and hospice resource utilization (average length of stay or ALOS, discharge rate, bed day use, outpatient consultation) analysed with reference to gender, risk activity, immunological and clinical staging (1987 definition of AIDS) for the financial year 1992-93 was undertaken at the Regional Infectious Disease Unit (RIDU), City Hospital, Edinburgh, Scotland where 72% of 513 patients were infected via injection drug use. Not surprising therefore overall, drug users were the heaviest users of the inpatient facilities (74% of the discharges and 65% of the bed days) although homosexuals had the highest discharge rate (114 per 100 person years) and rate of bed day use (1654 days per 100 person years). Immunodeficiency (CD4 count < 200 cells/ul) and a clinical diagnosis of AIDS were both associated with greater inpatient and outpatient resource use compared to those without immunodeficiency (CD4 count > or = 200 CD4 cells/ul) or AIDS. Gender effects were complex; the ALOS for women was increased for all risk groups whatever the CD4 count whilst there was no consistent trend of more resource use for women by risk group. Drug users were the heaviest overall users of the local hospice (84% of all admissions, 83% of the bed days and a discharge rate of 76.4 per 100 person years), more than double the rates experienced by the other risk groups. Thus both clinical and immunological staging (AIDS or a CD4 count < 200 cells/ul) were associated with increased resource use in HIV infection and estimates of resource use for AIDS need to be increased by around one-third to take into account hospice use. Despite the preponderance of drug users in Edinburgh, comparisons with other centres did not reveal increased resource use.

Health systems’ responses to 25 years of HIV in Europe: Inequities persist and challenges remain

“…For example one study among French IDUS found that approximately 50% of patients prescribed HAART take less than 80% of the treatment [152] while many IDUs remain reluctant to start HAART [158,159]. Consequently, IDUs with adherence problems have worse health outcomes than other PLWHA on HAART [152,160,161].…”

End-of-Life Issues in AIDS: The Research Perspective

“…In a prospective study by the Regional Infectious Disease Unit in Scotland, health service and hospice use by HIVinfected individuals was evaluated for 1992±93 12 . Most of the 513 patients (72%) had been infected through injection drug use.…”

Bacterial infections in HIV: the extent and nature of the problem

“…However pre-AIDS bed day use in Edinburgh, predominantly as a result of injection drug users, was greater than in London or Shef® eld; 460 days per 100 person years in Edinburgh compared to 271 in London and 209 in Shef® eld 36± 39 . On closer examination of the pre-AIDS discharge rate in Edinburgh revealed that it was 51 per 100 person years for drug users compared to 13 per 100 person years in homosexuals and bisexuals 39 . This increased pre-AIDS morbidity seems to be characteristic of IDUrelated HIV and much of it is related to problems with bacterial infections.…”