Asch S, Turner BJ, Bozzette SA, McCutchan JA, Gifford AL, Shapiro M, Kuromiya K; International Conference on AIDS.
Int Conf AIDS. 1998; 12: 815 (abstract no. 42213).
Thomas Jefferson University, Philadelphia, PA, USA.
OBJECTIVE: We evaluated HIV quality of care using a patient-centered, symptom-based framework. METHODS: Care was assessed for HIV+ patients who had any of 3 persistent, bothersome symptoms (SX) in past 6 months: cough and/or shortness of breath (C/SOB) > 1 wk., diarrhea (DIAR) > 1 wk., or weight loss (WL) > 10%. Clinical experts developed 14 quality of care indicators for these SX by defining appropriate history, physical, social service, diagnostic procedures, and therapies for specific clinical scenarios. Study subjects were identified by a 3-stage probability sampling design, in which site, providers in these sites and those providers' patients were randomly selected. Patients were interviewed from 1/96-3/97 and queried on demographics, socioeconomics, risk factors, recent CD4 count, and aspects of SX in the past 6 months. Patients with bothersome, persistent SX were asked about care for the most bothersome SX and one random SX. The final sample of 2865 respondents is used with preliminary weights to adjust for sampling, multiplicity, and nonresponse and linearization methods to correct for weights and multistage sample design. RESULTS: Care for C/SOB was asked of 530 (18%), DIAR of 985 (34%), WL of 543 (19%). Adherence to quality indicators ranged from 31% (endoscopy for chronic unresponsive DIAR) to 100% (hospitalization or antibiotics for CD4 < 200 and SOB with fever, chills, or hemoptosis). Adherence rates were < 80% for 6/14 indicators. Only 50% of patients had all appropriate quality of care indicators met (C/SOB = 38%, DIAR = 59%, WL = 74%). Adherence was worst for invasive procedures (50%) and best for physical exam (97%). In a DIAR scenario recommending endoscopy, only 6% of the uninsured had endoscopy vs 84% of patients with private health maintenance insurance. We found few demographic or socioecomomic predictors (p < .05) of adherence. DISCUSSION: Quality of care appears to be commonly deficient for three common symptoms in HIV+ patients in the US. Quality adherence rates are poorest for invasive, often expensive procedures and may be related to lack of insurance coverage. Futher characterization of factors preventing quality of care is warranted.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- CD4 Lymphocyte Count
- Cough
- Data Collection
- Diarrhea
- HIV Infections
- HIV Seropositivity
- Health Personnel
- Humans
- Insurance, Health
- Interviews as Topic
- Medically Uninsured
- Quality Indicators, Health Care
- Risk Factors
- Weight Loss
- diagnosis
- economics
Other ID:
UI: 102231012
From Meeting Abstracts