The 130th Annual Meeting of APHA

Abstract #45925

Brad Wohler-Torres, MS¹, Eduardo Valverde, MPH¹, Pamela Anderson-Mahoney, PhD², Maribel Barragan, MPH³, Anita M Loughlin, MS⁴, and Lisa R. Metsch, PhD¹. (1) Department of Epidemiology and Public Health, University of Miami School of Medicine, 1801 NW 9th Avenue, Suite 313, Miami, FL 33136, 305-243-2656, bwohler@med.miami.edu, (2) HIV Epidemiology Program, LAC-DHS, Los Angeles Count Department of Health Services, 600 S Commonwealth Ave, Ste 1801, Los Angeles, CA 90005, (3) School of Medicine, Emory University, 69 Butler Street, S.E., Atlanta, GA 30303, (4) School of Public Health, Johns Hopkins, 1235 E Monument St, Ste 210, Baltimore, MD 21205

Background: Adherence to medical appointments is important to the management of HIV disease. Missed appointments are associated with negative clinical outcomes such as inability to suppress HIV-1 RNA levels and few studies have assessed the effect of system barriers on medical appointment compliance. The ARTAS Site survey provides an opportunity to explore whether specific clinic characteristics and services are related to patients’ abilities to keep appointments. Methods: The Antiretroviral Treatment and Access Studies (ARTAS) included a mail survey of 138 HIV treatment facilities in four US cities (Atlanta, Baltimore, Los Angeles, and Miami). The survey, completed by clinic administrators, gathered information on clinic staffing, hours of operation, clinic services and patient attendance. Chi-Square and logistic regression analysis were used to estimate the association between missing appointments and site characteristics. Results: Over half of the clinics report that 11 – 75% of their patients miss their scheduled appointments on any given day. Our findings indicate that clinics with fewer than 4 providers (OR=0.25), and that offer mental health services (OR=.29) have fewer patients missing appointments. Alternatively, clinics providing Medicaid assistance (OR=7.30) and those clinics with more than 10% uninsured (OR=3.65) were more likely to have the majority of their patients missing scheduled appointments. Conclusion: Smaller clinics may offer more personalized attention leading to higher rates of appointment compliance. Availability of mental health services may also be an incentive for patients to keep their appointments. On the other hand, uninsured patients have a higher risk of noncompliance to medical appointments.

Learning Objectives:

• A lower percentage of HIV+ patients who access private clinics miss appointments compared to those who access other types of clinics.
• Certain services appear to reduce the frequency of missed appointments more effectively than other consumer-related services and program assistance.

Keywords: Access and Services, HIV/AIDS

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.