Repeated Emergency Department Use by HIV-Infected Persons: Effect of Clinic Accessibility and Expertise in HIV Care

Abstract

Repeated emergency department (ED) visits by HIV-infected persons may signify poor access to care or treatment from inexperienced ambulatory providers. We examined features of 157 clinics following 6820 HIV-infected patients and associations with repeated (> or =2) ED visits by these patients in the year before their first AIDS diagnosis. Patient clinical and health care data came from 1987-1992 New York State (NYS) Medicaid files and clinic data came from interviews of clinic directors. The HIV/AIDS experience of each study patient's clinic was measured as the annual number of Medicaid enrollees newly diagnosed with AIDS who were contemporaneously followed by the patient's clinic. Repeated ED use was observed for 24%. The adjusted odds ratio (AOR) of repeated ED visits was reduced for patients in clinics with a physician on-call (0.77; 95% confidence interval [CI] = 0.65, 0.92), evening or weekend clinic hours (0.77; 95% CI = 0.64, 0.93), or >50 AIDS patients/year in 1987-1988 (0.56; 95% CI = 0.44, 0.71) versus fewer patients in those years. Patients in clinics with more than one feature promoting accessibility or HIV expertise had a greater reduction in their AOR of repeated ED use. HIV-infected patients in clinics with greater accessibility and HIV expertise rely less on the ED for care.

The Impact of Youth-Friendly Structures of Care on Retention Among HIV-Infected Youth

“…Evening and weekend clinic hours promote clinic accessibility and have been shown to decrease repeated emergency department use and hospitalizations among people living with HIV. 37,38 Although extended clinic hours may broadly benefit people of all ages, YLHIV may especially benefit from the increased opportunities to access health services and engage in care as a historically underserved and difficult to reach population. 19,39,40 Although extended clinic hours or other alternative scheduling of clinical staff and building operations may be limited by available resources, future directions for incorporating structural changes in clinic settings should consider offering extended clinic hours to YLHIV clients and other vulnerable populations.…”

Housing status and health care service utilization among low-income persons with HIV/AIDS

“…These initiatives, which emphasized linking individuals into a comprehensive continuum of HIV treatment services, sought to expand the capacity for primary care delivery in a wide range of community and hospitalbased settings; instituted family-centered, intensive case management for HIV-infected Medicaid recipients; and promoted the establishment of centers of excellence for HIVrelated clinical care. 29,30 Together, these programs created a unique environment for the delivery of HIV-related health care, one potentially so unique as to restrict the generalizability of our study findings beyond New York State.…”

Structures of Care in the Clinics of the HIV Research Network

“…24 Physician on-call programs and evening or weekend clinic hours are associated with a reduction in the likelihood of repeat emergency department use. 25 The utilization of internal clinic mechanisms to handle acute patient issues could potentially decrease emergency department visits and hospitalizations. Furthermore, if emergency department referral or hospitalization is required, providers can communicate medical information to the hospital or emergency department staff more efficiently.…”