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People who have HIV experience more problems with inpatient than outpatient care

Caring for patients infected with the human immunodeficiency virus (HIV) that causes AIDS can be challenging, since they often have complex medical problems and associated treatments. A new study shows that these patients consistently report more problems with hospital care than outpatient care. For instance, 39 percent complained that their hospital clinicians communicated different things to them, and 28 percent said that their pain could have been dealt with more promptly. Most of the hospital problems reported by these patients could have been addressed by better provider-patient communication, according to the study, which was supported in part by the Agency for Healthcare Research and Quality (HS08578).

Outpatient care involves multiple types of interactions over time, giving patients and caregivers opportunities to make adjustments if patients experience problems. Also, patients can change providers until they find someone with whom they are happy. In contrast, hospital stays are often one-time experiences associated with acute and serious illness in which a great deal of diagnostic and therapeutic activity is compressed into a relatively short time period, explains Martin F. Shapiro, M.D., Ph.D., of the University of California, Los Angeles, School of Medicine. Dr. Shapiro and Samuel A. Bozzette, M.D., Ph.D., of the University of California, San Diego, were co-principal investigators of the HIV Cost and Services Utilization Study (HCSUS), which provides data on a national probability sample of people in care for HIV.

Overall, 1,074 patients provided ratings of an inpatient stay, and 2,204 patients rated an outpatient visit; 818 rated both inpatient and outpatient care. Mean problem rates were 21 percent for inpatient care and 8 percent for outpatient care. The mean global rating score for inpatient care was 65 (significantly lower than a national sample of hospitalized patients without HIV infection) and 75 for outpatient care (on a 0-100 scale, with 100 being the best care). Since site characteristics explained more of the variance in HIV care than patient characteristics, site processes of care and providers should be the focus of quality improvement efforts, according to the authors.

More details are in "HIV patients' experiences with inpatient and outpatient care: Results of a national survey," by Ira B. Wilson, M.D., M.Sc., Lin Ding, Ph.D., Ron D. Hays, Ph.D., and others, in the December 2002 Medical Care 40, pp. 1149-1160.

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