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Factors Associated with Missed Psychiatry Visits in an Urban HIV Clinic

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Abstract

Psychiatric co-management is often required in HIV primary care. While rates and clinical impact of linkage and retention in HIV are well explored, fewer investigations focus specifically on linkage to psychiatry. In this investigation, we evaluate factors associated with linkage to psychiatric services using a retrospective cohort study of HIV-infected patients during a two-year observation period. Descriptive statistics depict patient characteristics, and logistic regression models were fit to evaluate factors associated with failure to establish care at the co-located psychiatry clinic following referral from HIV provider. Of 370 referred, 23 % did not attend a scheduled psychiatry appointment within 6 months of initial referral. In multivariable analysis, Non-white race, younger age, non-suppressed viral load, and increased wait time to appointment (in days) were associated with failure to attend. Further exploration of barriers that contribute to disparate linkage to psychiatric care may inform future interventions to improve HIV outcomes in this population.

Resumen

El co-manejo con psiquiatria se requiere frecuentemente en el cuidado de pacientes con VIH. Mientras se conoce bastante sobre las tasas de vinculacion y retencion en la atencion del VIH, pocos studios se han enfocado en la vinculacion de pacientes en cuidados psiquiatricos. En esta investigación, evaluamos los factores asociados con la vinculación a servicios psiquiátricosde pacientes VIH positivos en un estudio retrospectivo de una cohorte de pacientes durante un periodo de observación de dos años. Se utilizan métodos estadísticos descriptivos para representar las características de los pacientes, y se ajustaron modelos de regresión logística para evaluar los factores asociados con el fracaso en el establecimiento de atención en la clínica de psiquiatría (vinculación) co-ubicada en el recinto de nuestra clínica de VIH siguiendo referimiento por el medico primario. De 370 pacientes referidos, el 23 % no acudieron a la cita programada después de seis meses tras el referimiento inicial. En el análisis multivariable, la raza no blanca, la edad más joven, la carga viral no suprimida, y un major tiempo de espera para la cita (en días) se asociaron con la no asistencia. Exploración adicional de las barreras que contribuyen a no establecer el vinculo inicial con psiquiatría podrá informar futuras intervenciones para mejorar los resultados clínicos en pacientes con VIH.

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Acknowledgments

We thank the UAB 1917 HIV/AIDS Clinic Cohort Observational Database project and the UAB Center for AIDS Research. Dr. James H. Willig and Christina Ho take responsibility for the integrity of the data and the accuracy of the data analysis. Data presented in part at the 6th International Conference on HIV Treatment and Prevention Adherence. May 22–24, 2011. Miami, Florida.

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Authors and Affiliations

  1. Department of Medicine, University of Alabama at Birmingham, BBRB 206B, 845 19th Street S, Birmingham, AL, 35294, USA

    Christina P. Ho, Anne Zinski, Susanne A. Fogger, Jonathan D. Peters, Andrew O. Westfall, Michael J. Mugavero, Sarah T. Lawrence, Christa R. Nevin, James L. Raper, Michael S. Saag & James H. Willig

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  1. Christina P. Ho
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  2. Anne Zinski
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  3. Susanne A. Fogger
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  4. Jonathan D. Peters
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  6. Michael J. Mugavero
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  7. Sarah T. Lawrence
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Correspondence to Anne Zinski or James H. Willig.

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Christina Ho and Anne Zinski request a co-first author designation, as both authors contributed equally to this manuscript.

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Ho, C.P., Zinski, A., Fogger, S.A. et al. Factors Associated with Missed Psychiatry Visits in an Urban HIV Clinic. AIDS Behav 19, 1423–1429 (2015). https://doi.org/10.1007/s10461-014-0967-9

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