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Medical clinic structure influences use of mental health and substance abuse care by persons with HIV disease

Persons with HIV disease commonly suffer from mental health problems and substance abuse, which typically interfere with their treatment and health. The likelihood of these patients receiving treatment for these problems depends, in part, on the structure of their medical clinic, concludes a new study.

Researchers found that patients who were cared for at HIV specialty clinics or clinics with a combination of case management and affiliated mental health care were twice as likely to be cared for by a mental health specialist as patients at other clinics. Those cared for at clinics with on-site case management and on-site or off-site affiliated substance abuse care were four and three times, respectively, more likely to receive outpatient substance abuse care than patients at other clinics. Finally, patients treated at clinics with on-site case management were nearly twice as likely to have a 30-day abstinence from substances at follow-up 6 months later than those at other clinics.

Case managers may facilitate linkage to mental health care and substance abuse care by making referrals, scheduling appointments, and arranging transportation, note the researchers. They surveyed patients and clinic directors at 200 clinics participating in the HIV Cost and Services Utilization Study, a nationally representative sample of persons in care for HIV. They examined the impact of medical clinic organizational characteristics on access to mental health and substance abuse care for patients with these problems. More than one-third (38 percent) of patients suffered from a psychiatric condition.

The study was supported in part by the Agency for Healthcare Research and quality (HS10408 and HS10222).

See "Medical clinic characteristics and access to behavioral health services for persons with HIV," by Michael E. Ohl, M.D., M.S.P.H., Bruce E. Landon, M.D., M.B.A., Paul D. Cleary, Ph.D., and Joseph LeMaster, M.D., M.P.H., in the April 2008 Psychiatric Services 59, pp. 400-407.

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