Abstract
BackgroundMany people living with HIV access healthcare systems through the emergency department (ED), and increased ED use may be indicative of disenfranchisement with primary HIV care, under-managed comorbid disease, or coincide with use of other healthcare resources. The goal of this study was to investigate ED use by HIV-infected prisoners transitioning to communities.MethodsWe evaluated ED use by 151 HIV-infected released prisoners who were enrolled in a randomized controlled trial of directly administered versus self-administered antiretroviral therapy in Connecticut. Primary outcomes were quantity and type of ED visits and correlates of ED use were evaluated with multivariate models by Poisson regression.ResultsIn the 12 months post-release, there were 227 unique ED contacts made by 85/151 (56%) subjects. ED visits were primarily for acute febrile syndromes (32.6%) or pain (20.3%), followed by substance use issues (19.4%), trauma (18%), mental illness (11%), and social access issues (4.4%). Compared to those not utilizing the ED, users were more likely to be white, older, and unmarried, with less trust in their physician and poorer perceived physical health but greater social support. In multivariate models, ED use was correlated with moderate to severe depression (IRR = 1.80), being temporarily housed (IRR = 0.54), and alcohol addiction severity (IRR = 0.21) but not any surrogates of HIV severity.ConclusionsEDs are frequent sources of care after prison-release with visits often reflective of social and psychiatric instability. Future interventions should attempt to fill resource gaps, engage released prisoners in continuous HIV care, and address these substantial needs.
Highlights
People living with HIV/AIDS (PLWHA) present to the emergency department (ED) significantly more often than their HIV-uninfected counterparts. [1] This increased ED use, does not necessarily reflect severity of illness: ED visits among PLWHA, when compared to those without HIV, are no more likely to result in hospitalization. [1] Despite Department of Health and Human Services guidelines recommendation for continuous outpatient HIV follow-up, [2] many PLWHA frequently interface with healthcare systems through the ED.Frequent and repetitive ED use represents excess cost to individuals and society in that most issues can often be addressed in primary care settings at lower premiums
A pattern of healthcare use with increased reliance on the ED may be emblematic of discontinuous primary care rather than more severe medical disease. [3,4] On the other hand, some PLWHA who are engaged in HIV care may use the ED based on the recommendation of their HIV provider, or alternatively, to meet different medical, psychiatric, and social needs during periods of extreme life instability. [5,6,7]
Because we expected that greater social and medical instability immediately following prison release would result in greater reliance on ED care, we examined the time to first ED visit from baseline
Summary
[1] Despite Department of Health and Human Services guidelines recommendation for continuous outpatient HIV follow-up, [2] many PLWHA frequently interface with healthcare systems through the ED. [16,17] As the ED is often the safety net provider for those without regular access to primary care services, understanding ED use in this vulnerable population is important for optimizing HIV treatment and other health-related outcomes. Many people living with HIV access healthcare systems through the emergency department (ED), and increased ED use may be indicative of disenfranchisement with primary HIV care, under-managed comorbid disease, or coincide with use of other healthcare resources. The goal of this study was to investigate ED use by HIV-infected prisoners transitioning to communities
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