Triply-diagnosed patients in the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study: patterns of home care use

1. In addition to the named authors, the members of the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study Subcommittee were as follows (those in bold-face served as members of the Subcommittee on Costs that developed the utilization survey and unit costs used in this paper): Steering Committee (Steering Committee Chair, CMHS Program Director, Consumer Liaison, Coordinating Center PI and Study Site Principal Investigators): Seth Kalichman, University of Connecticut; Storrs, CT; Mary C. Knipmeyer, Center for Mental Health Services, SAMHSA, Rockville, MD; Phil Meyer, Los Angeles, CA; James Bell, James Bell Associates, Arlington, VA; Marcia Andersen, Well-Being Institute, Detroit, MI; Robert Calsyn, University of Missouri, St. Louis, MO; Terence Keane, Boston University School of Medicine, Boston, MA; Stanley Sacks, National Development & Research Institutes, Inc., New York, NY; Tomas Soto, Cook County Bureau of Health Services/CORE Center, Chicago, IL; Karina Uldall, University of Washington, Seattle, WA; Mark Winiarski, Montefiore Medical Center, Bronx, NY; Kathryn Whetten, Duke University, Durham, NC. Federal Collaborators: Health Resources and Services Administration: Philomena Green-Morsell, Melinda Tinsley, HIV/AIDS Bureau, Rockville, MD; National Institutes of Health: Jerry Flanzer, National Institute on Drug Abuse, Bethesda, MD; David M. Stoff, National Institute of Mental Health, Bethesda, MD; and Kendall Bryant, Michael Hilton, National Institute on Alcohol and Alcoholism, Rockville, MD; Substance Abuse and Mental Health Services Administration: Mary C. Knipmeyer, Center for Mental Health Services (Lead Agency), Rockville, MD; David Thompson, Ali Manwar, Center for Substance Abuse Treatment, Rockville, MD. Collaborating Scientists – Co-Principal Investigators and Co-Investigators: Peter Arno, Montefiore Medical Center, Bronx, NY; Karen Bonuck, Montefiore Medical Center, Bronx, NY; Deborah Brief, Boston University School of Medicine, Boston, MA; Christopher J. Conover, Duke University, Durham, NC; Patrick Flynn, National Development & Research Institutes, Inc., Raleigh, NC; Victoria Harris, University of Washington, Seattle, WA; Thomas W. Helminiak, University of Missouri, St. Louis, MO; Ann Hendricks, Boston University School of Medicine, Boston, MA; W. Dean Klinkenberg, Missouri Institute of Mental Health, St. Louis, MO; Alec Miller, Montefiore Medical Center, Bronx, NY; Darlene Mood, Well-Being Institute, Detroit, MI; Gary A. Morse; Community Alternatives, St. Louis, MO; Susan Pfoutz, Well-Being Institute, Detroit, MI; Jim Porto, National Development & Research Institutes, Inc., Chapel Hill, NC; Rebecca Roberts, Cook County Hospital, Chicago, IL; Renslow Sherer, Cook County Bureau of Health Services/CORE Center, Chicago, IL; Laura Sadowski, Cook County Hospital; Chicago, IL; Geoffrey Smereck, Well-Being Institute, Detroit, MI; Marvin Swartz, Duke University Medical Center, Durham, NC; Glenn Trezza, Boston VA Medical Center, Boston, MA; Marcia Weaver, University of Washington, Seattle, WA; Robert Weinstein, Cook County Hospital, Chicago, IL.

Abstract

Although AIDS is a chronic illness, little is known about the patterns and correlates of long-term care use among triply diagnosed HIV patients. We examined nursing and home care use among 1,045 participants in the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study, a multi-site study of HIV-positive patients with at least one mental health and one substance disorder. Patient interviews and medical record review data were used to examine the average monthly cost of nursing home, formal home and informal home care. Multinomial logit and two-part regression models were used to identify correlates of the use of formal and informal home care and the number of informal home care hours used. During the three months prior to baseline, 2, 7 and 23% of participants used nursing home, formal home and informal home care, respectively. Patients who were better-educated, had higher incomes, had Medicaid insurance (with or without Medicare coverage) and whose transmission mode was homosexual sex had higher regression-adjusted probabilities of receiving any formal home care; Latinos and physically healthier patients had lower probabilities. Women and patients who abused drugs or alcohol (but not both) were more likely to receive informal care only. Overall, patients who were female, better-educated, physically or mentally sicker or single-substance abusers were more likely to receive any home care (either formal or informal), while those contracting HIV through heterosexual sex were less likely. Women received 28 more monthly hours of informal care than men and married patients received 31 more hours than unmarried patients. We conclude that at least one mutable policy factor (Medicaid insurance) is strongly associated with formal home care use among triply diagnosed patients. Further research is needed to explore possible implications for access among this vulnerable subpopulation.

Keywords:

• home care
• HIV/AIDS
• service use
• access
• cost analysis

Acknowledgements

This work was supported by a cooperative agreement for the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study, a collaboration of six Federal entities within the US Department of Health and Human Services (DHHS): The Center for Mental Health Services, which had the lead administrative responsibility, and the Center for Substance Abuse Treatment, both components of the Substance Abuse and Mental Health Services Administration (SAMHSA); the HIV/AIDS Bureau of the Health Resources and Services Administration (HRSA); the National Institute of Mental Health, the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, all parts of the National Institutes of Health (NIH). We dedicate this work to the patients and research staff who participated in the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study, without whom this research would not have been possible. The views expressed are those of the author(s) and are not to be construed as official or as reflecting the views or policies of the SAMHSA, the HRSA, the NIH or any other agencies of the DHHS.

Notes

1. In addition to the named authors, the members of the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study Subcommittee were as follows (those in bold-face served as members of the Subcommittee on Costs that developed the utilization survey and unit costs used in this paper): Steering Committee (Steering Committee Chair, CMHS Program Director, Consumer Liaison, Coordinating Center PI and Study Site Principal Investigators): Seth Kalichman, University of Connecticut; Storrs, CT; Mary C. Knipmeyer, Center for Mental Health Services, SAMHSA, Rockville, MD; Phil Meyer, Los Angeles, CA; James Bell, James Bell Associates, Arlington, VA; Marcia Andersen, Well-Being Institute, Detroit, MI; Robert Calsyn, University of Missouri, St. Louis, MO; Terence Keane, Boston University School of Medicine, Boston, MA; Stanley Sacks, National Development & Research Institutes, Inc., New York, NY; Tomas Soto, Cook County Bureau of Health Services/CORE Center, Chicago, IL; Karina Uldall, University of Washington, Seattle, WA; Mark Winiarski, Montefiore Medical Center, Bronx, NY; Kathryn Whetten, Duke University, Durham, NC. Federal Collaborators: Health Resources and Services Administration: Philomena Green-Morsell, Melinda Tinsley, HIV/AIDS Bureau, Rockville, MD; National Institutes of Health: Jerry Flanzer, National Institute on Drug Abuse, Bethesda, MD; David M. Stoff, National Institute of Mental Health, Bethesda, MD; and Kendall Bryant, Michael Hilton, National Institute on Alcohol and Alcoholism, Rockville, MD; Substance Abuse and Mental Health Services Administration: Mary C. Knipmeyer, Center for Mental Health Services (Lead Agency), Rockville, MD; David Thompson, Ali Manwar, Center for Substance Abuse Treatment, Rockville, MD. Collaborating Scientists – Co-Principal Investigators and Co-Investigators: Peter Arno, Montefiore Medical Center, Bronx, NY; Karen Bonuck, Montefiore Medical Center, Bronx, NY; Deborah Brief, Boston University School of Medicine, Boston, MA; Christopher J. Conover, Duke University, Durham, NC; Patrick Flynn, National Development & Research Institutes, Inc., Raleigh, NC; Victoria Harris, University of Washington, Seattle, WA; Thomas W. Helminiak, University of Missouri, St. Louis, MO; Ann Hendricks, Boston University School of Medicine, Boston, MA; W. Dean Klinkenberg, Missouri Institute of Mental Health, St. Louis, MO; Alec Miller, Montefiore Medical Center, Bronx, NY; Darlene Mood, Well-Being Institute, Detroit, MI; Gary A. Morse; Community Alternatives, St. Louis, MO; Susan Pfoutz, Well-Being Institute, Detroit, MI; Jim Porto, National Development & Research Institutes, Inc., Chapel Hill, NC; Rebecca Roberts, Cook County Hospital, Chicago, IL; Renslow Sherer, Cook County Bureau of Health Services/CORE Center, Chicago, IL; Laura Sadowski, Cook County Hospital; Chicago, IL; Geoffrey Smereck, Well-Being Institute, Detroit, MI; Marvin Swartz, Duke University Medical Center, Durham, NC; Glenn Trezza, Boston VA Medical Center, Boston, MA; Marcia Weaver, University of Washington, Seattle, WA; Robert Weinstein, Cook County Hospital, Chicago, IL.