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Greater access to clinics reduces the risk of hospitalization for poor people with advanced HIV disease

Hospitalization of people infected with HIV is not only costly, it also exposes them to the risk of hospital-acquired infections and complications. Poor individuals with advanced HIV disease who visit clinics with extended hours or other accessibility features have 23 percent lower odds of being hospitalized than those who visit less accessible clinics. Also, patients followed in clinics with at least four accessibility features (expanded clinic hours, case management, availability of urgent care in the clinic, and rapid scheduling of appointments) have one-third lower odds of being hospitalized than those treated at clinics with only one accessibility feature.

Unfortunately, the most accessible clinics comprised only 27 percent of surveyed clinics and served only one-fifth of New York's Medicaid-insured patients with advanced HIV disease, according to a study supported by the Agency for Health Care Policy and Research (HS06465). Promoting clinic accessibility—for example, by extending clinic hours—may increase the cost of providing outpatient care. Yet these up-front costs may be far less than the expenditures required to treat hospitalized HIV patients, which are frequently borne by public hospitals, notes Christine Laine, M.D., of Thomas Jefferson University. Dr. Laine and her colleagues retrospectively analyzed the New York State Medicaid HIV/AIDS research database entries from 1984 through 1992. They also surveyed directors of clinics serving Medicaid enrollees in the State with advanced HIV disease to identify clinic features associated with a lower risk of hospitalization.

Nearly half of the 6,840 clinic patients studied were hospitalized during the year before AIDS diagnosis. Extended clinic hours, availability of health care providers for telephone consultation, and a clinic case manager (who can encourage regular followup and predict long-term care needs) were significantly associated with reduced hospitalization in the year before AIDS diagnosis. Difficulty in contacting providers or obtaining appointments at the time of need may hinder timely receipt of outpatient services and lead to conditions that require hospitalization, conclude the researchers.

See "Relationship between ambulatory care accessibility and hospitalization for persons with advanced HIV disease," by Dr. Laine, Leona Markson, Sc.D., Thomas R. Fanning, Ph.D., and Barbara J. Turner, M.D., M.S.Ed., in the Journal of Health Care for the Poor and Underserved 10(3), pp. 313-327, 1999.

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