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Abstract #150143
Perrin B. Lawrence, MPH1, John A. Fleishman, PhD2, Michelande Ridoré, BA1, P. Todd Korthuis, MD3, and Kelly A. Gebo, MD1. (1) Johns Hopkins School of Medicine, 1830 E Monument Street, Baltimore, MD 21205, 410-614-1995, plawren5@jhmi.edu, (2) Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, (3) Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
Background: HIV+ injection drug users (IDU's) may have different utilization patterns than HIV+ non-IDU's. Methods: Medical records of 27,928 HIV+ adults in primary care in 2005 at 10 sites in USA were abstracted. Utilization for IDU's and non-IDU's was compared, stratified by CD4, using incidence rate ratios (IRR) and negative binomial regression with IDU x CD4 interaction term. Results: The sample was 72% male, 44% Black, 21% Hispanic, median age 43. HIV risk: 46% MSM, 31% heterosexual, 17% IDU. Median CD4 379 cells/mm3. Utilization rates in Table 1. IDU's with higher CD4's had more outpatient utilization than non-IDU's (interaction term p<.05). Inpatient not significant. Conclusions: HIV+ IDU's in primary care have higher rates of both inpatient and outpatient utilization than non-IDU's. Providers should work to decrease expensive inpatient utilization for IDU's. IDU's with higher CD4 have particularly high rates of outpatient utilization compared to non-IDU's.
Table 1. Utilization Rates by IDU Status
|
|
IDU |
Non-IDU |
IRR* |
95% CI |
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|
|
N |
Visit Rate |
N |
Visit Rate |
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|
Outpatient** |
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CD4≤50 |
136 |
5.76 |
836 |
6.21 |
0.93 |
0.86-1.00 |
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51-200 |
379 |
6.37 |
1495 |
5.41 |
1.18 |
1.12-1.23 |
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201-350 |
521 |
6.34 |
2201 |
5.06 |
1.25 |
1.20-1.30 |
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351-500 |
448 |
5.65 |
2199 |
4.79 |
1.18 |
1.13-1.23 |
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>500 |
612 |
5.53 |
3420 |
4.74 |
1.17 |
1.12-1.21 |
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Inpatient*** |
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|
|
|
|
|
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CD4≤50 |
136 |
114.97 |
836 |
94.62 |
1.20 |
1.00-1.43 |
|
51-200 |
379 |
64.38 |
1495 |
38.60 |
1.67 |
1.43-1.94 |
|
201-350 |
521 |
38.20 |
2201 |
18.45 |
2.07 |
1.74-2.46 |
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351-500 |
448 |
25.90 |
2199 |
14.46 |
1.79 |
1.43-2.22 |
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>500 |
612 |
21.24 |
3420 |
12.16 |
1.75 |
1.42-2.13 |
* IDU vs Non-IDU; ** Rate per patient year; *** Rate per 100 patient years
Learning Objectives:
- List differences in healthcare utilization patterns between HIV+ injection drug users (IDU's) and HIV+ non-IDU's.
- Understand the interaction between CD4 count and IDU status as it relates to utilization.
- Develop strategies to reduce expensive inpatient utilization by IDU's.
Keywords: HIV/AIDS, Utilization
Related Web page: www.hopkinsmedicine.org/hivresearchnetwork
Presenting author's disclosure statement:
Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.
The 135th APHA Annual Meeting & Exposition (November 3-7, 2007) of APHA