Wednesday, March 12, 2008
The un-insured or under-insured use the emergency department (ED) as their main source of primary medical-care and sometimes require inpatient hospitalization (IP) or ambulatory care (OP).
To determine the hospital facilities utilization behavior of South Carolina's (SC) adult HIV-infected population based on their HIV medical-care status.
A data file of all adult SC residents reported to the HARS and alive at December 31st, 2003 was linked to statewide all payer health-care database to determine visits for 2004-2005. A hospital visit was categorized as either ED only, IP only, OP only or all. In HIV care was defined as receipt of a viral load test or CD4 cell count during calendar years 2004-2005. Logistic regression was used to estimate relationships between hospital utilization and demographic and behavioral factors.
Of the 13,042 HIV-infected adults, 5,130/13,042 (39%) made one or more visits to a hospital facility in 2004-2005 amounting to 35,959 visits (median 4; range 1–88).
Of these individuals, 2,027/5,130 (40%) visited EDs only, 439/5,130 (9%) IP only, 531/5,130 (10%) OP only, whereas 2,133/5,130 (42%) visited all. 2,407/5,130 (47%) individuals were not in HIV care.
Persons least likely to be in HIV care had more IP only visits (OR 0.65, 95%CI: 0.44, 0.97). Females making any visit were more likely to be in HIV care compared to men (OR 1.30, 95%CI: 1.08, 1.57) while persons with no identifiable risk making any visit were less likely in HIV care compared to heterosexuals with any visit (OR 0.71 95% CI: 0.58, 0.88).
HIV-infected individuals not in HIV care continue to make visits to hospital facilities, and these visits represent missed opportunities for recruiting not in care persons back into HIV care.
Programs to enhance linkage to HIV care should focus on individuals not in HIV care and hospital facilities should have improved HIV referral practices.