title: Triply-diagnosed patients in the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study: patterns of home care use.
abstract: Although AIDS is a chronic illness, little is known about the patterns and correlates of long-term care use among triply diagnosed HIV patients. We examined nursing and home care use among 1,045 participants in the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study, a multi-site study of HIV-positive patients with at least one mental health and one substance disorder. Patient interviews and medical record review data were used to examine the average monthly cost of nursing home, formal home and informal home care. Multinomial logit and two-part regression models were used to identify correlates of the use of formal and informal home care and the number of informal home care hours used. During the three months prior to baseline, 2, 7 and 23% of participants used nursing home, formal home and informal home care, respectively. Patients who were better-educated, had higher incomes, had Medicaid insurance (with or without Medicare coverage) and whose transmission mode was homosexual sex had higher regression-adjusted probabilities of receiving any formal home care; Latinos and physically healthier patients had lower probabilities. Women and patients who abused drugs or alcohol (but not both) were more likely to receive informal care only. Overall, patients who were female, better-educated, physically or mentally sicker or single-substance abusers were more likely to receive any home care (either formal or informal), while those contracting HIV through heterosexual sex were less likely. Women received 28 more monthly hours of informal care than men and married patients received 31 more hours than unmarried patients. We conclude that at least one mutable policy factor (Medicaid insurance) is strongly associated with formal home care use among triply diagnosed patients. Further research is needed to explore possible implications for access among this vulnerable subpopulation.
authors.affiliation: Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA. settner@mednet.ucla.edu
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Conover
authors.forename: Rae Jean
authors.initials: RJ
authors.lastname: Proescholdbell
authors.forename: Marcia R
authors.initials: MR
authors.lastname: Weaver
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ang
authors.forename: Peter S
authors.initials: PS
authors.lastname: Arno
mesh_terms: D000293:Adolescent; D000328:Adult; D003365:Costs and Cost Analysis; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D015658:HIV Infections / Q000150:complications / Q000191:economics / Q000451:nursing*; D005102:Health Expenditures; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data*; D006701:Home Nursing / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007341:Insurance / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000191:economics / Q000451:nursing*; D008875:Middle Aged; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000150:complications / Q000191:economics / Q000451:nursing*; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult