Effect of case management on unmet needs and utilization of medical care and medications among HIV-infected persons.
BACKGROUND
Although case management has been advocated as a method for improving the care of chronically ill persons, its effectiveness is poorly understood.


OBJECTIVE
To assess the effect of case managers on unmet need for supportive services and utilization of medical care and medications among HIV-infected persons.


METHODS
Baseline and follow-up interview of a national probability sample.


METHODS
Inpatient and outpatient medical facilities in the United States.


METHODS
2437 HIV-infected adults representing 217 081 patients receiving medical care.


METHODS
Outcomes measured at follow-up were unmet need for supportive services, medical care utilization (ambulatory visits, emergency department visits, and hospitalizations), and use of HIV medication (receipt of antiretroviral therapy and prophylaxis against Pneumocystis carinii pneumonia and toxoplasmosis).


RESULTS
At baseline, 56.5% of the sample had contact with a case manager in the previous 6 months. In multiple logistic regression analyses that adjusted for potential confounders, contact with a case manager at baseline was associated with decreased unmet need for income assistance (odds ratio [OR], 0.57 [95% CI, 0.36 to 0.91]), health insurance (OR, 0.54 [CI, 0.33 to 0.89]), home health care (OR, 0.29 [CI, 0.15 to 0.56]), and emotional counseling (OR, 0.62 [CI, 0.41 to 0.94]) at follow-up. Contact with case managers was not significantly associated with utilization of ambulatory care (OR, 0.77 [CI, 0.57 to 1.04]), hospitalization (OR, 1.13 [CI, 0.84 to 1.54]), or emergency department visits (OR, 1.30 [CI, 0.97 to 1.73]) but was associated with higher utilization of two-drug (OR, 1.58 [CI, 1.23 to 2.03]) and three-drug (OR, 1.34 [CI, 1.00 to 1.80]) antiretroviral regimens and of treatment with protease inhibitors or non-nucleoside reverse transcriptase inhibitors (OR, 1.29 [CI, 1.02 to 1.64]) at follow-up.


CONCLUSIONS
Case management appears to be associated with fewer unmet needs and higher use of HIV medications in patients receiving HIV treatment.
Katz
M H
MH
Department of Public Health, 101 Grove Street, Room 308, San Francisco, CA 94102-4505, USA. mitch_katz@dph.sf.ca.us
Cunningham
W E
WE
Fleishman
J A
JA
Andersen
R M
RM
Kellogg
T
T
Bozzette
S A
SA
Shapiro
M F
MF
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D019090:Case Management; D015986:Confounding Factors, Epidemiologic; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006296:Health Services / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D012044:Regression Analysis; D014481:United States
D019380:Anti-HIV Agents