title: Patients referred to an urban HIV clinic frequently fail to establish care: factors predicting failure.
abstract: To measure the success with which patients newly entering outpatient care establish regular care, and assess whether race/ethnicity was a predictive factor, we conducted a medical record review of new patients seen 20 April 1998 to 31 December 1998 at The Thomas Street Clinic, a county clinic for uninsured persons. Patients were considered 'not established' if they never saw a physician in the 6 months after intake (the 'initial period'), 'poorly established' if seen but a > 6-month gap in care began in the initial period, and 'established' if there were no such gaps. Of 404 patients, 11% were 'not established', 37% 'poorly established', and 53% 'established'. Injection drug use as HIV risk factor (IDU), admitted current alcohol and drug use, age < 35 years, and CD4 count > or = 200 cells/mm(3) were most common in the 'not established' group and least common in the 'established' group. In multivariate ordinal logistic regression, difficulty establishing care was associated with IDU, admitted current alcohol use, and admitted former drug use. Age > 35 years was protective. Half the indigent patients entering care in this single-site study fail to establish regular care. Substance use and younger age are predictors of failure to establish care.
authors.affiliation: Baylor College of Medicine, Texas, USA. tpg@bcm.tmc.edu
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Giordano
authors.forename: Fehmida
authors.initials: F
authors.lastname: Visnegarwala
authors.forename: A Clinton
authors.initials: AC
authors.lastname: White
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Troisi
authors.forename: Ralph F
authors.initials: RF
authors.lastname: Frankowski
authors.forename: Christine M
authors.initials: CM
authors.lastname: Hartman
authors.forename: Richard M
authors.initials: RM
authors.lastname: Grimes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000592:standards; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010349:Patient Compliance; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D019037:Urban Health Services / Q000592:standards