Routine rapid HIV testing in hospitals: Another opportunity for hospitalists to improve care

Greenwald, Jeffrey L.

doi:10.1002/jhm.66

Cited by 13 publications

(12 citation statements)

References 21 publications

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“…In these instances, hospitalists must ensure that patients' immunizations are up‐to‐date and arrange appropriate follow‐up care with primary care providers. Greenwald described an important role that hospitalists could play in HIV prevention by promoting HIV testing in the hospital 26. The CDC recently confirmed the wisdom of this approach and estimates that the 250,000 to 1.2 million people in the United States with HIV infection who do not know their serostatus play a significant role in HIV transmission 26, 27.…”

Section: Assessmentmentioning

confidence: 99%

“…Greenwald described an important role that hospitalists could play in HIV prevention by promoting HIV testing in the hospital 26. The CDC recently confirmed the wisdom of this approach and estimates that the 250,000 to 1.2 million people in the United States with HIV infection who do not know their serostatus play a significant role in HIV transmission 26, 27. In an effort to promote testing, the CDC has initiated a program aimed at incorporating HIV testing into routine medical care, as recommended by others 28.…”

Section: Assessmentmentioning

confidence: 99%

“…In an effort to promote testing, the CDC has initiated a program aimed at incorporating HIV testing into routine medical care, as recommended by others 28. More than a quarter of patients with HIV in the United States are diagnosed in the hospital, and for many other patients, hospitalization is their only real opportunity to be tested 26, 29. Similarly, when hospitalists find elevated cholesterol or triglycerides in routine evaluations of patients who present with chest pain, they have to decide whether to initiate lipid‐lowering medications 30.…”

Section: Assessmentmentioning

confidence: 99%

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Expanding the roles of hospitalist physicians to include public health

Kisuule

Minter‐Jordan

Zenilman

et al. 2007

Journal of Hospital Medicine

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Several years after the inception of the hospitalist movement, hospitalist roles have evolved in breadth and sophistication. Although public health is not formally recognized or previously described as an arena for hospitalists, hospitalists are often engaged in public health practice. This article attempts to alert hospitalists to the potential to make contributions to the field of public health and defines the public health skills that can positively affect the lives of their patients and the communities they serve. In a public health role, hospitalists may improve the quality of inpatient care. This article reviews how public health and hospital-based practices have already intersected and proposes further development within this discipline. In our ever-changing health care system, hospitalists play key roles in the central public health domains of assessment, assurance, and policy development. Insightful hospitalists will recognize and embrace these responsibilities in caring for patients and society. Journal of Hospital Medicine 2007;2:93-101.

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Section: Assessmentmentioning

confidence: 99%

Section: Assessmentmentioning

confidence: 99%

Section: Assessmentmentioning

confidence: 99%

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Expanding the roles of hospitalist physicians to include public health

Kisuule

Minter‐Jordan

Zenilman

et al. 2007

Journal of Hospital Medicine

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“…4 Concern over patient reactions to this style of HIV testing program should not be considered a significant barrier to program institution. While we do not have information on why patients refused HIV testing, the recent study by Wurcel et al 10 suggests that prior testing and self-perception of being at low risk for HIV were the most common reasons.…”

Section: Discussionmentioning

confidence: 99%

Approaching the CDC's Guidelines on the HIV Testing of Inpatients: Physician-Referral versus Nonreferral-Based Testing

Greenwald

Hall²,

Skolnik³

2006

AIDS Patient Care and STDs

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Despite ongoing evidence that one quarter of HIV-infected people in the United States are unaware of their infection, widespread implementation of the Centers for Disease Control and Prevention's 1993 recommendations regarding routine inpatient HIV testing has not occurred. This study compares two HIV testing strategies: the initial phase of inpatient HIV testing (1999-2001) utilized a physician-referral-based system. The second phase (2001-2003) included the first 2 years' experience with having trained HIV counselors directly approach inpatients regarding their willingness to undergo voluntary HIV counseling and testing (VCT)without physician referral. This latter phase was prompted by a patient attitude survey demonstrating favorable responses to unsolicited approaches by staff regarding HIV testing. Barriers to implementing the latter strategy are discussed and initial experience with rapid HIV testing on this service is also presented. Referral-based testing yielded 2.3 patient referrals (6.4% of total admissions) resulting in 1.2 HIV tests and 0.7 counseling only sessions per day. Nonreferral based testing resulted 6.2 HIV tests and another 3.0 counseling-only sessions per day. HIV VCT on an inpatient service is feasible but challenging. Most patients respond favorably to being approached for VCT. Routinely offering HIV tests to inpatients yields higher testing rates than physician referral-based systems and increases the number of patients who know their HIV status. Recommendations for implementing routing HIV testing on an inpatient service are made. 311

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“…13 Hospitalization in patients with HIV infection could be either due to a HIV-related condition, other comorbid conditions or a combination of both. While others have studied reasons for hospitalization among patients with HIV infection, we are unaware of research documenting the causes of hospitalization among patients first diagnosed with HIV during hospitalization.…”

Section: Introductionmentioning

confidence: 99%

Causes of Hospitalization and Perceived Access to Care Among Persons Newly Diagnosed with HIV Infection: Implications for HIV Testing Programs

Shahani

Hartman

Troisi³

et al. 2012

AIDS Patient Care and STDs

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There has been little research on the causes of hospitalization when patients are first diagnosed with HIV in the hospital. Reduced access to care could partially explain inpatient diagnosis. We sought to determine if the patients diagnosed as inpatients are hospitalized due to a HIV-related cause versus some other causes, to compare access to care of patients diagnosed with HIV in hospital and outpatient settings, and to determine factors associated with access to care. Participants were newly diagnosed with HIV and recruited between January 2006 and August 2007. The reason for hospitalization was classified as HIV-related, other infectious cause, noninfectious cause, or miscellaneous cause. Access to care was self-reported using a six-item scale and scores were compared with the t test. Multivariate linear regression determined factors associated with improved access to care. Of 185 participants in the study, 78 were diagnosed in hospital and 107 in outpatient settings. Thirty-two percent of participants were female, 90% were racial/ethnic minority, 45% had no high school diploma, and 85% were uninsured. HIV-related conditions accounted for 60% of admissions, followed by non-infectious causes (20%) and other infectious causes (17%). Inpatients did not report less access to care than patients diagnosed while outpatients. Multivariate analysis demonstrated improvement in access to care with better health insurance ( p = 0.01) and greater education ( p = 0.08). HIV-related preventable conditions account for many hospitalizations when patients are first diagnosed with HIV. While socioeconomic factors are associated with perceived access to care, persons diagnosed in the inpatient setting do not report lower perceived access to care than persons diagnosed as outpatients, suggesting other barriers to earlier diagnosis.

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Routine rapid HIV testing in hospitals: Another opportunity for hospitalists to improve care

Cited by 13 publications

References 21 publications

Expanding the roles of hospitalist physicians to include public health

Expanding the roles of hospitalist physicians to include public health

Approaching the CDC's Guidelines on the HIV Testing of Inpatients: Physician-Referral versus Nonreferral-Based Testing

Causes of Hospitalization and Perceived Access to Care Among Persons Newly Diagnosed with HIV Infection: Implications for HIV Testing Programs

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