Patients referred to an urban HIV clinic frequently fail to establish care: factors predicting failure

To measure the success with which patients newly entering outpatient care establish regular care, and assess whether race/ethnicity was a predictive factor, we conducted a medical record review of new patients seen 20 April 1998 to 31 December 1998 at The Thomas Street Clinic, a county clinic for un...

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Bibliographic Details
Published in:AIDS care 2005-08, Vol.17 (6), p.773-783
Main Authors: Giordano, Thomas P., Visnegarwala, Fehmida, White, A. Clinton, Troisi, Catherine L., Frankowski, Ralph F., Hartman, Christine M., Grimes, Richard M.
Format: Article
Language:English
Subjects:
access
Adolescent
Adult
Aged
AIDS
AIDS/HIV
Ambulatory Care - standards
Antiretroviral Therapy, Highly Active
appointments
Biological and medical sciences
Clinics
Ethnicity
Failure
Female
Health behavior
Health care
Health services utilization
HIV
HIV Infections - drug therapy
Human immunodeficiency virus
Human viral diseases
Humans
Infectious diseases
Inner city
Male
Medical care
Medical Records
Medical research
Medical sciences
Middle Aged
Outpatient treatment
Participation
Patient Compliance
Patients
Poverty
Predictors
Public health
Referral and Consultation
Regression analysis
Retrospective Studies
Risk Factors
Substance abuse
substance use
Texas
Treatment Failure
U.S.A
Urban areas
Urban Health Services - standards
USA
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
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Summary:To measure the success with which patients newly entering outpatient care establish regular care, and assess whether race/ethnicity was a predictive factor, we conducted a medical record review of new patients seen 20 April 1998 to 31 December 1998 at The Thomas Street Clinic, a county clinic for uninsured persons. Patients were considered 'not established' if they never saw a physician in the 6 months after intake (the 'initial period'), 'poorly established' if seen but a > 6-month gap in care began in the initial period, and 'established' if there were no such gaps. Of 404 patients, 11% were 'not established', 37% 'poorly established', and 53% 'established'. Injection drug use as HIV risk factor (IDU), admitted current alcohol and drug use, age  / = 200 cells/mm 3 were most common in the 'not established' group and least common in the 'established' group. In multivariate ordinal logistic regression, difficulty establishing care was associated with IDU, admitted current alcohol use, and admitted former drug use. Age > 35 years was protective. Half the indigent patients entering care in this single-site study fail to establish regular care. Substance use and younger age are predictors of failure to establish care.
ISSN:0954-0121
1360-0451
DOI:10.1080/09540120412331336652