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

Abstract

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 < 35 years, and CD4 count > / = 200 cells/mm³ 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.

Keywords:

• HIV
• AIDS
• patient compliance
• appointments
• access
• substance use

Acknowledgments

The authors would like to acknowledge Jamie Baker, B.S., for assistance with the data collection.

Supported in part by the Harris County Hospital District and the resources and facilities of the Department of Veterans Affairs. Dr. Giordano received support from NIH grants T32AI07456 and K23MH67505. Presented in part at the 2nd International AIDS Society Conference on HIV Pathogenesis and Treatment, Paris, France, July 13–16, 2003 (Abstract Number 751).