Abstract
Timely access to medical care is important for HIV+ individuals. Standards of care are needed that identify inappropriate delays in receiving care for serious symptoms. We evaluated the reliability and construct validity of provider-based standards for timely care for HIV symptoms, and applied these standards to data from the HIV Cost and Services Utilization Study (HCSUS), a national probability sample of HIV+ persons in care. HIV physicians estimated appropriate time to care HIV+ individuals should receive for headache, cough, diarrhea, or weight loss. Timely care was defined as receiving care by the mean provider-specified acceptable number of days to care, by specific CD4 count, compared to receiving care after the mean days to care. Sensitivity analyses were performed on the provider standards. Inter-rater reliability between physicians for timely care estimates was high (0.97). Up to 70% of HIV+ individuals from the HCSUS survey did not receive timely care for their most bothersome symptom. Physicians rated patients with lower CD4 counts (<200 cells/ml) as requiring care within a shorter period of time. However, patients with lower CD4 counts (<200 cells/ml) were no more likely or less likely to receive timely care. Physicians considered headache and cough more urgent than weight loss. Yet patients with headache or cough were the least likely to receive timely care. In a national probability sample, time to care for a majority of HIV patients for their most bothersome symptoms exceeded provider-based standards. Further research is needed on reasons for this mismatch.
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Kilbourne, A.M., Asch, S., Andersen, R.M. et al. Development and Application of a Method to Assess Timeliness of Medical Care for HIV Symptoms. Health Services & Outcomes Research Methodology 2, 101–115 (2001). https://doi.org/10.1023/A:1020102028911
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DOI: https://doi.org/10.1023/A:1020102028911