文章基本信息

标题：Who’s In and Who’s Out: Use of Primary Medical Care Among People Living With HIV
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作者：Beth E. Meyerson ; W. Dean Klinkenberg ; Donna R. Perkins 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：4
页码：744-749
DOI：10.2105/AJPH.2006.090654
语种：English
出版社：American Public Health Association
摘要：Objectives. We sought to achieve a more comprehensive picture of access to medical care for the treatment of HIV (HIV primary care) by combining evidence of medical services used (health utilization) and epidemiological client-level data. Methods. This study integrated health information from several data sources to measure utilization of HIV primary care in the St Louis, Mo, area between 1998 and 2002. Data from disparate HIV health utilization databases were combined with data from the Missouri HIV and AIDS Reporting System database and then deidentified to measure client-level utilization of HIV primary care over time. Results. About half of those with HIV showed evidence of having utilized HIV primary care in a given year. Although most of this group utilized HIV primary care in the first year after they received their HIV diagnosis, evidence of subsequent utilization was inconsistent. Utilization of primary care was most strongly associated with an AIDS diagnosis. About one quarter of people diagnosed with HIV after 1997 had an AIDS diagnosis when they first tested positive for HIV. Conclusions. This study was the first of its kind to integrate several databases to understand HIV primary health care utilization over a period of years. Our findings reinforce the importance of CD4 and viral load values as indicators of utilization of HIV primary health care, particularly in the absence of other health data sets. The lack of available data and the way in which source data were available limited the study. Since the implementation of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act in 1990, communities have tried to gain a comprehensive picture of medical utilization for the treatment of HIV (HIV primary care) with incomplete, separately held, and often summarized information. Communities receiving federal funding through the Ryan White CARE Act must assess HIV primary care utilization by persons living with HIV in their jurisdiction. Current regulation requires a seemingly never-ending array of incompatible data for this analysis. Often, some data report client-level health care utilization while other data report utilization by groups or subpopulations, rendering the data incomparable. 1 ^, 2 There have been recent attempts, funded by the US Health Resources and Services Administration, the agency that administers funding from the Ryan White CARE Act, to estimate the unmet need for HIV primary care through a comparison of epidemiological data and service utilization data. 2 ^– 6 Of this recent generation of studies, 2 studies, conducted in Louisiana and Georgia, used client-level data to understand utilization of HIV primary care. 4 The Louisiana study relied on mandatory lab-based reporting to estimate unmet need for HIV primary care services in 2002 and found that 45% of those reported as living with HIV disease did not receive a viral load or CD4 test during the 2002 period. The authors also found that the proportion of people in care varied considerably by geographic region. The findings were considered conservative because laboratory reporting was not 100% complete, the use of HIV and AIDS Reporting System (HARS) data was inflated (because the system does not track movement out of the state [migration]), and HIV primary care utilization data were not used as another indicator for HIV primary care access. 4 The Atlanta study attempted to combine several care data sets for the year 2001. Adjustments were made with the Health Cost and Utilization Project’s Nationwide Inpatient Sample and with data from private insurers. An estimated 33% of people reported with HIV disease did not receive HIV primary medical care. The estimate of unmet need for people with HIV (non-AIDS) was greater (51%) than for people living with AIDS (19%). In the Atlanta study, findings were limited because of the inability of HARS to track migration and the difficulty with missing data elements from source data sets that challenged deduplication of client-level data. All studies have the same goal: to more effectively describe unmet need for HIV primary care services in a way that is accessible to service and policy planners and have the ability to be replicated by communities across the United States. 4 In our study, we continued the development of comprehensive data sources as indicators of HIV primary care utilization by expanding the time period of review to 5 years and by integrating several data sources at client level to create a more inclusive understanding of HIV primary care utilization. We proposed the following research questions: (1) Among people who have been diagnosed with HIV or AIDS and are living in the St Louis region, how many are utilizing medical care to treat their HIV? (2) What differences exist between those who are and those who are not receiving HIV primary care? (3) How do people who have been diagnosed with HIV or AIDS interact with the health system?