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

TLDR

The study measured how successfully newly entering patients establish regular outpatient care and evaluated race/ethnicity as a potential predictor. Patients were classified as not established, poorly established, or established based on physician visits within six months of intake, and a medical record review of 404 new patients at an uninsured county clinic was performed from April to December 1998. Among 404 patients, 11% were never established, 37% poorly established, and 53% fully established; multivariate analysis showed injection drug use, current alcohol use, and former drug use predicted failure to establish care, while age >35 was protective, indicating that substance use and younger age are key predictors of failure.

Abstract

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.