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Propensity of HIV patients to seek urgent and emergent care

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Abstract

OBJECTIVE: To assess the propensity of HIV-infected adults to seek care for common symptoms, and to determine whether they would seek care in the emergency department (ED) or with their primary care provider.

DESIGN: Cross-sectional interview study.

SETTING: Patients in care in the 48 contiguous United States.

PARTICIPANTS: A nationally representative group of HIV-infected adults selected using multistage probability sampling.

MEASUREMENTS: Subjects were interviewed between January 1996 and April 1997. Patients with advanced disease (past AIDS diagnosis and/or CD4 cell count <200/µL) and early disease were asked how they would seek care for key HIV-associated symptom complexes. Three advanced disease and 3 early disease symptom scenarios were used.

MAIN RESULTS: Most advanced disease patients (78% to 87%) would seek care right away from the ED or primary care provider for the symptoms asked. Most early disease patients (82%) would seek care right away for new respiratory symptoms; fewer would do so for headache (46%) or oral white patches (62%). In a multivariate model, independent predictors of propensity to use the ED for advanced disease symptoms included African-American ethnicity (adjusted odds ratio [OR], 2.5; 95% confidence interval [95% CI], 1.8 to 3.4); less education (adjusted OR, 1.4; 95% CI, 1.1 to 1.7); drug dependence (adjusted OR, 1.4; 95% CI, 1.1 to 1.7); annual income less than $5,000 (adjusted OR, 1.5; 95% CI, 1.0 to 2.3); and lower psychological well-being (adjusted OR, 0.9; 95% CI, 0.9 to 1.0). In early disease, the following independently predicted ED use: African American (adjusted OR, 4.7; 95% CI, 3.1 to 7.1) or Hispanic ethnicity (adjusted OR 2.4; 95% CI, 1.4 to 4.3), female gender (adjusted OR, 1.6; 95% CI, 1.2 to 2.2), annual income less than $5,000 (adjusted OR, 1.8; 95% CI, 1.1 to 3.0), and lower psychological well-being (adjusted OR, 0.9; 95% CI, 0.8 to 1.0).

CONCLUSIONS: Many patients would use the ED instead of same-day primary care for several common symptoms of HIV disease. African Americans, the poor, and patients with psychological symptoms had a higher propensity to use the ED.

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Author information

Authors and Affiliations

  1. the Health Services Research and Development Program, VA San Diego Healthcare System, San Diego, Calif

    Allen L. Gifford MD & Samuel A. Bozzette MD, PhD

  2. University of California San Diego School of Medicine, La Jolla, Calif

    Allen L. Gifford MD, David Timberlake MPH & Samuel A. Bozzette MD, PhD

  3. University of California Los Angeles School of Medicine, Los Angeles, Calif

    Mark A. Schuster MD, PhD & Martin F. Shapiro MD, PhD

  4. RAND Health, Santa Monica, Calif

    Allen L. Gifford MD, Rebecca Collins PhD, Martin F. Shapiro MD, PhD, Samuel A. Bozzette MD, PhD & David E. Kanouse PhD

Authors
  1. Allen L. Gifford MD
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  2. Rebecca Collins PhD
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  3. David Timberlake MPH
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  4. Mark A. Schuster MD, PhD
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  5. Martin F. Shapiro MD, PhD
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  6. Samuel A. Bozzette MD, PhD
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  7. David E. Kanouse PhD
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Corresponding author

Correspondence to Allen L. Gifford MD.

Additional information

This work was conducted under cooperative agreement HS08578 (M.F. Shapiro, Pl; S.A. Bozzette, Co-Pl) between RAND and the Agency for Health Care Policy and Research. Substantial additional support for this agreement was provided by the Health Resources and Services Administration, the National Institute for Mental Health and the National Institute for Drug Abuse. Additional support was provided by the Robert Wood Johnson Foundation, Princeton, NJ; Merck & Co., West Point, Pa; Glaxo-Wellcome Inc., Research Triangle Park, NC; the National Institute on Aging; and the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services, Washington, DC. Dr. Gifford is supported by the Department of Veteran Affairs. Dr. Bozzette is a Health Services Research and Development Senior Research Associate of the Department of Veterans’ Affairs.

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Gifford, A.L., Collins, R., Timberlake, D. et al. Propensity of HIV patients to seek urgent and emergent care. J GEN INTERN MED 15, 833–840 (2000). https://doi.org/10.1046/j.1525-1497.2000.91136.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2000.91136.x

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