Differences in HIV care between patients with and without severe mental illness.
OBJECTIVE
This study explored how HIV care differs for infected persons with and without severe mental illness.


METHODS
Data were obtained through interviews with and chart review of 295 patients with severe mental illness and HIV from public mental health agencies in Los Angeles County and New York City. Data were compared with data from 1,294 HIV patients without severe mental illness from a separate national probability sample. Measures were difficulty obtaining care, whether patients recommend their HIV care provider, hospital problem score, functional health status, and disability days.


RESULTS
In Los Angeles, HIV patients with severe mental illness were more likely than those without severe mental illness to have difficulty obtaining care (p<.001); to not recommend their provider (10% versus 5%, p=.007); and to have problematic hospital care (p=.001), poor health status (p=.001), and more disability days (p<.001). In New York City, HIV patients with severe mental illness were more likely than patients without severe mental illness to have difficulty obtaining care (p=.002) and not recommend their provider (p=.02). The relationship between severe mental illness and health status in Los Angeles and access in New York City became insignificant after adjustment for sociodemographic factors, drug use, and CD4 cell count. Further adjustment for higher case management rates among HIV patients with severe mental illness reduced disparities only in the West.


CONCLUSIONS
Patients with severe mental illness experienced more problems with HIV care than patients without severe mental illness, although high case management rates for patients with severe mental illness may have offset some problems.
Fremont
Allen M
AM
Department of Health, RAND Corporation, 1776 Main St., Santa Monica, CA 90407, USA. fremont@rand.org
Young
Alexander S
AS
Chinman
Matthew
M
Pantoja
Philip
P
Morton
Sally
S
Koegel
Paul
P
Sullivan
Greer
G
Kanouse
David
D
D000293:Adolescent; D000328:Adult; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D015141:Los Angeles; D008297:Male; D008485:Medical Audit; D001523:Mental Disorders; D008875:Middle Aged; D009519:New York City; D010818:Practice Patterns, Physicians'