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Case management appears to be associated with fewer unmet needs among people with HIV infection

HIV-positive people who have case managers are more likely to be using life-prolonging HIV medications and meeting their needs for income support, health insurance, home health care, and emotional counseling than those without case managers, according to recent findings from the HIV Cost and Services Utilization Study (HCSUS). Because an increasing proportion of HIV-infected people are living in poverty and need both supportive services and medical treatment, case managers may be particularly useful allies to clinicians and their patients, says Martin F. Shapiro, M.D., Ph.D., of the University of California, Los Angeles, HCSUS co-principal investigator, along with Samuel Bozzette, M.D., Ph.D., of the University of California, Los Angeles.

The study, a national probability sample of 2,437 HIV-infected adults, representing 217,081 people receiving HIV care throughout the United States, is supported in part by the Agency for Healthcare Research and Quality (HS08578). The researchers examined the relationship between having a case manager at baseline (1996 and 1997) and unmet needs 6 months later. Case managers included social workers, nurses, and AIDS service organization staff members assigned to help patients obtain and coordinate care. Overall, 57 percent of patients had contact with a case manager in the 6 months before the baseline interview.

This contact reduced patients' unmet need for income assistance and health insurance and substantially reduced unmet need for home health care and emotional counseling at followup. Contact with a case manager was not significantly associated with use of outpatient care, hospitalization, or emergency department visits, but it was associated with higher use of two-drug and three-drug antiretroviral regimens at followup. Case managers may help patients overcome fears about treatment, adhere to medication regimens, and keep medical appointments, and they may even function as patient advocates to doctors to initiate treatment for their patients.

See "Effect of case management on unmet needs and utilization of medical care and medications among HIV-infected persons," by Mitchell H. Katz, M.D., William E. Cunningham, M.D., M.P.H., John A. Fleishman, Ph.D., and others, in the October 16, 2001, Annals of Internal Medicine 135(8), pp. 557-565.

Reprints (AHRQ Publication No. 02-R011) are available from the AHRQ Publications Clearinghouse.

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