Propensity of HIV patients to seek urgent and emergent care. HIV Cost and Services Utilization Study Consortium.
OBJECTIVE
To assess the propensity of HIV-infected adults to seek care for common symptoms, and to determine whether they would seek care in the emergency department (ED) or with their primary care provider.


METHODS
Cross-sectional interview study.


METHODS
Patients in care in the 48 contiguous United States.


METHODS
A nationally representative group of HIV- infected adults selected using multistage probability sampling.


METHODS
Subjects were interviewed between January 1996 and April 1997. Patients with advanced disease (past AIDS diagnosis and/or CD4 cell count <200/microL) and early disease were asked how they would seek care for key HIV-associated symptom complexes. Three advanced disease and 3 early disease symptom scenarios were used.


RESULTS
Most advanced disease patients (78% to 87%) would seek care right away from the ED or primary care provider for the symptoms asked. Most early disease patients (82%) would seek care right away for new respiratory symptoms; fewer would do so for headache (46%) or oral white patches (62%). In a multivariate model, independent predictors of propensity to use the ED for advanced disease symptoms included African-American ethnicity (adjusted odds ratio [OR], 2.5; 95% confidence interval [95% CI], 1.8 to 3.4); less education (adjusted OR, 1.4; 95% CI, 1.1 to 1.7); drug dependence (adjusted OR, 1.4; 95% CI, 1.1 to 1.7); annual income less than $5,000 (adjusted OR, 1.5; 95% CI, 1.0 to 2.3); and lower psychological well-being (adjusted OR, 0.9; 95% CI, 0.9 to 1.0). In early disease, the following independently predicted ED use: African American (adjusted OR, 4.7; 95% CI, 3.1 to 7.1) or Hispanic ethnicity (adjusted OR 2.4; 95% CI, 1.4 to 4.3), female gender (adjusted OR, 1.6; 95% CI, 1.2 to 2.2), annual income less than $5,000 (adjusted OR, 1.8; 95% CI, 1.1 to 3. 0), and lower psychological well-being (adjusted OR, 0.9; 95% CI, 0. 8 to 1.0).


CONCLUSIONS
Many patients would use the ED instead of same-day primary care for several common symptoms of HIV disease. African Americans, the poor, and patients with psychological symptoms had a higher propensity to use the ED.
Gifford
A L
AL
Health Services Research and Development Program, VA San Diego Healthcare System, San Diego, Calif, USA. agifford@ucsd.edu
Collins
R
R
Timberlake
D
D
Schuster
M A
MA
Shapiro
M F
MF
Bozzette
S A
SA
Kanouse
D E
DE
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000208:ethnology / Q000523:psychology; D006261:Headache / Q000175:diagnosis; D006801:Humans; D007971:Leukoplakia / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*; D011159:Population Surveillance; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000175:diagnosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States