Document Detail

The association between primary source of ambulatory care and access to and outcomes of treatment among AIDS patients.
MedLine Citation:
PMID:  10501599     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To examine the relationship between having a primary source of ambulatory care (PSAC), access to AIDS treatment and prophylaxis for opportunistic infection, and hospital and mortality outcomes among heterosexual men and women with AIDS. METHODS: Using a linked AIDS Registry-Medicaid database, 366 adults were identified (1989-1991) with at least 1 year of continuous Medicaid enrollment before AIDS diagnosis, who survived 2 weeks after diagnosis, and with no antiretroviral use or Pneumocystis carinii pneumonia (PCP) prophylaxis during the pre-diagnosis year. Outcomes included times to zidovudine treatment, PCP prophylaxis, hospitalization and death following diagnosis. Multivariate proportional hazards models were used to estimate the effects of patients' PSAC status in the 12-month post-diagnosis period on outcomes, controlling for demographic and case-mix variables. RESULTS: Study criteria preferentially included females, non-whites and enrollees eligible on the basis of aid to families with dependent children. A total of 49% of the patients had no PSAC. Patients with a PSAC were more likely to have received zidovudine [relative risk (RR) = 1.75, 95% confidence interval (CI) = 1.2, 2.2] or PCP prophylaxis (RR = 2.22, 95% CI = 1.5, 3.3). Regression models simultaneously examining association of the propensity to use zidovudine and PCP prophylaxis agents with death indicated that zidovudine-treated and PCP-prophylaxed patients were 64% and 51% less likely to die, respectively (RRdeath,zidovudine = (.36, 95% CI = 0.2, 0.4; RRdeath, PCP prophylaxis = 0.49, 95% CI = 0.3, 0.8). CONCLUSIONS: Patients' underuse of zidovudine and PCP prophylaxis was systematically associated with not having a PSAC. Lack of PSAC, in turn, predicted shorter survival but not increased hospitalization. Female gender, injecting drug use, non-white race and earlier diagnosis year also predicted poorer outcomes.
T J McLaughlin; S B Soumerai; D Weinrib; O Aupont; D Cotton
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  International journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua     Volume:  11     ISSN:  1353-4505     ISO Abbreviation:  Int J Qual Health Care     Publication Date:  1999 Aug 
Date Detail:
Created Date:  1999-11-17     Completed Date:  1999-11-17     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9434628     Medline TA:  Int J Qual Health Care     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  293-300     Citation Subset:  IM; X    
Department of Ambulatory Care and Prevention, Harvard Medical School and the Harvard Pilgrim Health Care, Boston, MA 02215, USA.
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MeSH Terms
AIDS-Related Opportunistic Infections / mortality*,  prevention & control
Acquired Immunodeficiency Syndrome / mortality*,  prevention & control
Health Services Accessibility*
Middle Aged
New Jersey / epidemiology
Outcome Assessment (Health Care)*
Outpatient Clinics, Hospital*
Primary Health Care*
Sex Factors
Substance-Related Disorders
Survival Analysis
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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