150143 Healthcare Utilization by IDU's vs. non-IDU's in a Multisite, Multistate Sample of HIV Patients In Care In 2005

Wednesday, November 7, 2007

Perrin B. Lawrence, MPH , Johns Hopkins School of Medicine, Baltimore, MD
John A. Fleishman, PhD , Agency for Healthcare Research and Quality, Rockville, MD
Michelande Ridoré, BA , Johns Hopkins School of Medicine, Baltimore, MD
P. Todd Korthuis, MD , Oregon Health and Sciences University, Portland, OR
Kelly A. Gebo, MD , Epidemiology Department, Johns Hopkins School of Medicine, Baltimore, MD

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

 

N

Visit Rate

N

Visit Rate

 

Outpatient**

 

 

 

 

 

 

CD4≤50

136

5.76

836

6.21

0.93

0.86-1.00

51-200

379

6.37

1495

5.41

1.18

1.12-1.23

201-350

521

6.34

2201

5.06

1.25

1.20-1.30

351-500

448

5.65

2199

4.79

1.18

1.13-1.23

>500

612

5.53

3420

4.74

1.17

1.12-1.21

Inpatient***

 

 

 

 

 

 

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

351-500

448

25.90

2199

14.46

1.79

1.43-2.22

>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:
1. List differences in healthcare utilization patterns between HIV+ injection drug users (IDU's) and HIV+ non-IDU's. 2. Understand the interaction between CD4 count and IDU status as it relates to utilization. 3. Develop strategies to reduce expensive inpatient utilization by IDU's.

Keywords: HIV/AIDS, Utilization

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.

See more of: STI/HIV Surveillance, Mental Health, and Service Utilization
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