AIDS and Behavior

, Volume 18, Issue 8, pp 1511–1522 | Cite as

Outcomes of HIV-Infected Patients Receiving Care at Multiple Clinics

  • Baligh R. Yehia
  • Asher J. Schranz
  • Florence Momplaisir
  • Sara C. Keller
  • Robert Gross
  • Ian Frank
  • Joshua P. Metlay
  • Kathleen A. Brady
Original Paper

Abstract

Receiving care at multiple clinics may compromise the therapeutic patient-provider alliance and adversely affect the treatment of people living with HIV. We evaluated 12,759 HIV-infected adults in Philadelphia, PA between 2008 and 2010 to determine the effects of using multiple clinics for primary HIV care. Using generalized estimating equations with logistic regression, we examined the relationship between receiving care at multiple clinics (≥1 visit to two or more clinics during a calendar year) and two outcomes: (1) use of ART and (2) HIV viral load ≤200 copies/mL for patients on ART. Overall, 986 patients (8 %) received care at multiple clinics. The likelihood of attending multiple clinics was greater for younger patients, women, blacks, persons with public insurance, and for individuals in their first year of care. Adjusting for sociodemographic factors, patients receiving care at multiple clinics were less likely to use ART (AOR = 0.62, 95 % CI 0.55–0.71) and achieve HIV viral suppression (AOR = 0.78, 95 % CI 0.66–0.94) than individuals using one clinic. Qualitative data are needed to understand the reasons for visiting multiple clinics.

Keywords

HIV care HIV clinics Use of multiple clinics HIV outcomes Viral suppression 

References

  1. 1.
    Nutting PA, Goodwin MA, Flocke SA, Zyzanski SJ, Stange KC. Continuity of primary care: to whom does it matter and when? Ann Fam Med. 2003;1(3):149–55.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Sweeney KG, Gray DP. Patients who do not receive continuity of care from their general practitioner–are they a vulnerable group? Br J Gen Pract. 1995;45(392):133–5.PubMedCentralPubMedGoogle Scholar
  3. 3.
    Institute of Medicine. Primary Care: America’s Health in a New Era. Washington DC: National Academy Press; 1996.Google Scholar
  4. 4.
    Fletcher RH, O’Malley MS, Fletcher SW, Earp JA, Alexander JP. Measuring the continuity and coordination of medical care in a system involving multiple providers. Med Care. 1984;22(5):403–11.PubMedCrossRefGoogle Scholar
  5. 5.
    Sundararajan V, Konrad TR, Garrett J, Carey T. Patterns and determinants of multiple provider use in patients with acute low back pain. J Gen Intern Med. 1998;13(8):528–33.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Wasson JH, Sauvigne AE, Mogielnicki RP, Frey WG, Sox CH, Gaudette C, et al. Continuity of outpatient medical care in elderly men. A randomized trial. JAMA. 1984;252(17):2413–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Parchman ML, Pugh JA, Noel PH, Larme AC. Continuity of care, self-management behaviors, and glucose control in patients with type 2 diabetes. Med Care. 2002;40(2):137–44.PubMedCrossRefGoogle Scholar
  8. 8.
    Ulett KB, Willig JH, Lin HY, Routman JS, Abroms S, Allison J, et al. The therapeutic implications of timely linkage and early retention in HIV care. AIDS Patient Care STDS. 2009;23(1):41–9.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Berg MB, Safren SA, Mimiaga MJ, Grasso C, Boswell S, Mayer KH. Nonadherence to medical appointments is associated with increased plasma HIV RNA and decreased CD4 cell counts in a community-based HIV primary care clinic. AIDS Care. 2005;17(7):902–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Giordano TP, White AC Jr, Sajja P, Graviss EA, Arduino RC, Adu-Oppong A, et al. Factors associated with the use of highly active antiretroviral therapy in patients newly entering care in an urban clinic. J Acquir Immune Defic Syndr. 2003;32(4):399–405.PubMedCrossRefGoogle Scholar
  11. 11.
    Sethi AK, Celentano DD, Gange SJ, Moore RD, Gallant JE. Association between adherence to antiretroviral therapy and human immunodeficiency virus drug resistance. Clin Infect Dis. 2003;37(8):1112–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Giordano TP, Gifford AL, White AC Jr, Suarez-Almazor ME, Rabeneck L, Hartman C, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44(11):1493–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Mugavero MJ, Lin HY, Willig JH, Westfall AO, Ulett KB, Routman JS, et al. Missed visits and mortality among patients establishing initial outpatient HIV treatment. Clin Infect Dis. 2009;48(2):248–56.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Metsch LR, Pereyra M, Messinger S, Del Rio C, Strathdee SA, Anderson-Mahoney P, et al. HIV transmission risk behaviors among HIV-infected persons who are successfully linked to care. Clin Infect Dis. 2008;47(4):577–84.PubMedCrossRefGoogle Scholar
  15. 15.
    Yehia BR, Fleishman JA, Metlay JP, Korthuis PT, Agwu AL, Berry SA, et al. Comparing different measures of retention in outpatient HIV care. AIDS. 2012;26(9):1131–9.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Fleishman JA, Yehia BR, Moore RD, Korthuis PT, Gebo KA. Establishment, retention, and loss to follow-up in outpatient HIV care. J Acquir Immune Defic Syndr. 2012;60(3):249–59.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Signs Vital. HIV Prevention Through Care and Treatment—United States. MMWR Morb Mortal Wkly Rep. 2011;2(60):1618–23.Google Scholar
  18. 18.
    Lucas GM, Chaisson RE, Moore RD. Highly active antiretroviral therapy in a large urban clinic: risk factors for virologic failure and adverse drug reactions. Ann Intern Med. 1999;131(2):81–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Giordano TP, Visnegarwala F, White AC Jr, Troisi CL, Frankowski RF, Hartman CM, et al. Patients referred to an urban HIV clinic frequently fail to establish care: factors predicting failure. AIDS Care. 2005;17(6):773–83.PubMedCrossRefGoogle Scholar
  20. 20.
    Valenstein P, Leiken A, Lehmann C. Test-ordering by multiple physicians increases unnecessary laboratory examinations. Arch Pathol Lab Med. 1988;112(3):238–41.PubMedGoogle Scholar
  21. 21.
    Green JL, Hawley JN, Rask KJ. Is the number of prescribing physicians an independent risk factor for adverse drug events in an elderly outpatient population? Am J Geriatr Pharmacother. 2007;5(1):31–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Elstad E, Carpenter DM, Devellis RF, Blalock SJ. Patient decision making in the face of conflicting medication information. Int J Qual Stud Health Well-being. 2012;7:1–11.PubMedCrossRefGoogle Scholar
  23. 23.
    Carpenter DM, DeVellis RF, Fisher EB, DeVellis BM, Hogan SL, Jordan JM. The effect of conflicting medication information and physician support on medication adherence for chronically ill patients. Patient Educ Couns. 2010;81(2):169–76.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Beach MC, Keruly J, Moore RD. Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV? J Gen Intern Med. 2006;21(6):661–5.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Apollo A, Golub SA, Wainberg ML, Indyk D. Patient-provider relationships, HIV, and adherence: requisites for a partnership. Soc Work Health Care. 2006;42(3–4):209–24.PubMedCrossRefGoogle Scholar
  26. 26.
    DiNenno E, Denning P. Communities in crisis: is there a generalized HIV epidemic in impoverished Urban areas of the United States?. 2013. http://www.cdc.gov/hiv/topics/surveillance/resources/other/poverty.htm. Accessed 25 Mar 2013.
  27. 27.
    Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. 2013. http://www.aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf. Accessed 25 Mar 2013.
  28. 28.
    Giordano TP, White AC Jr, Sajja P, Graviss EA, Arduino RC, Adu-Oppong A, et al. Factors associated with the use of highly active antiretroviral therapy in patients newly entering care in an urban clinic. J Acquir Immune Defic Syndr. 2003;32(4):399–405.PubMedCrossRefGoogle Scholar
  29. 29.
    Giordano TP, Gifford AL, White AC Jr, Suarez-Almazor ME, Rabeneck L, Hartman C, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44(11):1493–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Health Services and Resources Administration. HAB HIV core clinical performance measures for adult/adolescent clients: group 1 2008. 2013. http://hab.hrsa.gov/deliverhivaidscare/files/habgrp1pms08.pdf. Accessed 25 Mar 2013.
  31. 31.
    Yehia BR, Mehta JM, Ciuffetelli D, Moore RD, Pham PA, Metlay JP, et al. Antiretroviral medication errors remain high but are quickly corrected among hospitalized HIV-infected adults. Clin Infect Dis. 2012;55(4):593–9.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    DeLorenze GN, Follansbee SF, Nguyen DP, Klein DB, Horberg M, Quesenberry CP Jr, et al. Medication error in the care of HIV/AIDS patients: electronic surveillance, confirmation, and adverse events. Med Care. 2005;43(9 Suppl):63–8.Google Scholar
  33. 33.
    Lewis S, Foreman J. Low-cost diagnostic technologies and clinical outcomes. The impact of inappropriate utilization. International journal of technology assessment in health care. Fall. 1997;13(4):501–11.Google Scholar
  34. 34.
    van Walraven C, Naylor CD. Do we know what inappropriate laboratory utilization is? A systematic review of laboratory clinical audits. JAMA. 1998;280(6):550–8.PubMedCrossRefGoogle Scholar
  35. 35.
    May TA, Clancy M, Critchfield J, Ebeling F, Enriquez A, Gallagher C, et al. Reducing unnecessary inpatient laboratory testing in a teaching hospital. Am J Clin Pathol. 2006;126(2):200–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Vegting IL, van Beneden M, Kramer MH, Thijs A, Kostense PJ, Nanayakkara PW. How to save costs by reducing unnecessary testing: lean thinking in clinical practice. Eur J Intern Med. 2012;23(1):70–5.PubMedCrossRefGoogle Scholar
  37. 37.
    Kwok J, Jones B. Unnecessary repeat requesting of tests: an audit in a government hospital immunology laboratory. J Clin Pathol. 2005;58(5):457–62.PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Westert GP, Satariano WA, Schellevis FG, van den Bos GA. Patterns of comorbidity and the use of health services in the Dutch population. Eur J Public Health. 2001;11(4):365–72.PubMedCrossRefGoogle Scholar
  39. 39.
    Himelhoch S, Weller WE, Wu AW, Anderson GF, Cooper LA. Chronic medical illness, depression, and use of acute medical services among Medicare beneficiaries. Med Care. 2004;42(6):512–21.PubMedCrossRefGoogle Scholar
  40. 40.
    Broemeling AM, Watson DE, Prebtani F. Population patterns of chronic health conditions, co-morbidity and healthcare use in Canada: implications for policy and practice. Healthc Q. 2008;11(3):70–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Struijs JN, Baan CA, Schellevis FG, Westert GP, van den Bos GA. Comorbidity in patients with diabetes mellitus: impact on medical health care utilization. BMC Health Serv Res. 2006;6:84.PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Rajabiun S, Mallinson RK, McCoy K, Coleman S, Drainoni ML, Rebholz C, et al. “Getting me back on track”: the role of outreach interventions in engaging and retaining people living with HIV/AIDS in medical care. AIDS Patient Care STDs. 2007;21(Suppl 1):S20–9.PubMedGoogle Scholar
  43. 43.
    Tobias CR, Cunningham W, Cabral HD, Cunningham CO, Eldred L, Naar-King S, et al. Living with HIV but without medical care: barriers to engagement. AIDS Patient Care STDs. 2007;21(6):426–34.PubMedCrossRefGoogle Scholar
  44. 44.
    City of Philadelphia Department of Public Health AIDS Activities Coordinating Office. Program services Philadelphia. 2012. http://www.phila.gov/health/aaco/AACOProgramServices.html. Accessed 20 Feb 2013.
  45. 45.
    Berenson RA, Hammons T, Gans DN, Zuckerman S, Merrell K, Underwood WS, et al. A house is not a home: keeping patients at the center of practice redesign. Health Aff (Millwood). 2008;27(5):1219–30.CrossRefGoogle Scholar
  46. 46.
    Cooper L. Disparities in patient experiences, health care processes, and outcomes: the role of patient-provider racial, ethnic, and language concordance. New York: The Commonwealth Fund; 2004.Google Scholar
  47. 47.
    Clucas C, Harding R, Lampe FC, Anderson J, Date HL, Johnson M, et al. Doctor-patient concordance during HIV treatment switching decision-making. HIV Med. 2011;12(2):87–96.PubMedCrossRefGoogle Scholar
  48. 48.
    King WD, Wong MD, Shapiro MF, Landon BE, Cunningham WE. Does racial concordance between HIV-positive patients and their physicians affect the time to receipt of protease inhibitors? J Gen Intern Med. 2004;19(11):1146–53.PubMedCentralPubMedCrossRefGoogle Scholar
  49. 49.
    Coleman S, Boehmer U, Kanaya F, Grasso C, Tan J, Bradford J. Retention challenges for a community-based HIV primary care clinic and implications for intervention. AIDS Patient Care STDs. 2007;21(9):691–701.PubMedCentralPubMedCrossRefGoogle Scholar
  50. 50.
    Armstrong K, Ravenell KL, McMurphy S, Putt M. Racial/ethnic differences in physician distrust in the United States. Am J Public Health. 2007;97(7):1283–9.PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Hall MA, Zheng B, Dugan E, Camacho F, Kidd KE, Mishra A, et al. Measuring patients’ trust in their primary care providers. Med Care Res Rev. 2002;59(3):293–318.PubMedCrossRefGoogle Scholar
  52. 52.
    Peirce GL, Smith MJ, Abate MA, Halverson J. Doctor and pharmacy shopping for controlled substances. Med Care. 2012;50(6):494–500.PubMedCrossRefGoogle Scholar
  53. 53.
    Pearson SD, Katzelnick DJ, Simon GE, Manning WG, Helstad CP, Henk HJ. Depression among high utilizers of medical care. J Gen Intern Med. 1999;14(8):461–8.PubMedCentralPubMedCrossRefGoogle Scholar
  54. 54.
    Lefevre F, Reifler D, Lee P, Sbenghe M, Nwadiaro N, Verma S, et al. Screening for undetected mental disorders in high utilizers of primary care services. J Gen Intern Med. 1999;14(7):425–31.PubMedCentralPubMedCrossRefGoogle Scholar
  55. 55.
    Savageau JA, McLoughlin M, Ursan A, Bai Y, Collins M, Cashman SB. Characteristics of frequent attenders at a community health center. J Am Board Fam Med. 2006;19(3):265–75.PubMedCrossRefGoogle Scholar
  56. 56.
    Neal RD, Heywood PL, Morley S. Frequent attenders’ consulting patterns with general practitioners. Br J Gen Pract. 2000;50(461):972–6.PubMedCentralPubMedGoogle Scholar
  57. 57.
    Scaife B, Gill P, Heywood P, Neal R. Socio-economic characteristics of adult frequent attenders in general practice: secondary analysis of data. Fam Pract. 2000;17(4):298–304.PubMedCrossRefGoogle Scholar
  58. 58.
    Chou FY, Holzemer WL. Linking HIV/AIDS clients’ self-care with outcomes. J Assoc Nurses AIDS Care. 2004 Jul-Aug;15(4):58-67.Google Scholar
  59. 59.
    Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. 2002;288(19):2469–75.PubMedCrossRefGoogle Scholar
  60. 60.
    Gifford AL, Groessl EJ. Chronic disease self-management and adherence to HIV medications. J Acquir Immune Defic Syndr. 2002;15(31 Suppl 3):S163–6.CrossRefGoogle Scholar
  61. 61.
    Swendeman D, Ingram BL, Rotheram-Borus MJ. Common elements in self-management of HIV and other chronic illnesses: an integrative framework. AIDS Care. 2009;21(10):1321–34.PubMedCentralPubMedCrossRefGoogle Scholar
  62. 62.
    Gaston GB, Alleyne-Green B. The Impact of African Americans’ Beliefs About HIV Medical Care on Treatment Adherence: a Systematic Review and Recommendations for Interventions. AIDS Behav. 2012;17(1):31–40.CrossRefGoogle Scholar
  63. 63.
    Bogart LM, Wagner G, Galvan FH, Banks D. Conspiracy beliefs about HIV are related to antiretroviral treatment nonadherence among african american men with HIV. J Acquir Immune Defic Syndr. 2010;53(5):648–55.PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Baligh R. Yehia
    • 1
    • 2
  • Asher J. Schranz
    • 3
  • Florence Momplaisir
    • 4
  • Sara C. Keller
    • 1
  • Robert Gross
    • 1
    • 2
    • 5
  • Ian Frank
    • 1
  • Joshua P. Metlay
    • 6
  • Kathleen A. Brady
    • 1
    • 7
  1. 1.Department of Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Philadelphia Veterans Affairs Center for Health Equity Research and PromotionPhiladelphiaUSA
  3. 3.Department of MedicineNew York UniversityNew YorkUSA
  4. 4.Department of MedicineTemple University School of MedicinePhiladelphiaUSA
  5. 5.Department of Biostatistics and Epidemiology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  6. 6.General Medicine DivisionMassachusetts General HospitalBostonUSA
  7. 7.Philadelphia Department of Public HealthAIDS Activities Coordinating OfficePhiladelphiaUSA

Personalised recommendations