Source: contagionlive.com<\/p>\n
Early intervention and primary care are crucial for managing HIV. Not receiving this care can lead to health complications and costly hospital visits for people infected with HIV, a new study found.
The study, published in\u00a0Open Forum Infectious Diseases<\/em>, analyzed the health records of 2063 people infected with HIV who received care at St. James\u2019s Hospital in Dublin, Ireland, from October 2014 to October 2015.
\u201cA small number of people living with HIV (PLWHIV) with mental health, addiction and social challenges (eg homelessness) don\u2019t engage in outpatient HIV care and end up really sick and needing a lot of expensive hospital care,\u201d Cl\u00edona N\u00ed Cheallaigh, MB, MRCP, PhD, associate professor, Department of Clinical Medicine, Trinity College Dublin and consultant physician at St. James’s Hospital, told\u00a0Contagion<\/em>\u00ae<\/sup>. \u201cWe could potentially save a lot of money by helping these people take their ART and maintain their health.\u201d
Investigators found that 22 of 2063 patients had cumulative hospital stays of longer than 30 days during the study period. These high-cost, high-need users logged 99 emergency department visits and 1581 inpatient bed days, costing the hospital about $1 million during the study period. For 18 of those patients, the requirements that brought them to the hospital were potentially preventable, including 2 who had a late diagnosis of HIV and 16 who had advanced HIV.
\u201cThe amount of money (nearly 1 million euro on just 1 year\u2019s worth of hospital care) was much more than we expected,\u201d N\u00ed Cheallaigh told\u00a0Contagion<\/em>\u00ae<\/sup>. \u201cThis money could potentially have been used more effectively in preventing these people becoming sick\u2014ie by providing them with housing, social supports and addiction care.\u201d
In Ireland, HIV care and antiretroviral drugs are provided free of charge at university teaching hospitals like St. James\u2019s, with primary care provided by general practitioners working as independent contractors. General practitioner care is provided free for individuals with low income.
Barriers to relatively inexpensive primary care, including addiction, psychiatric disease and homelessness, affected 14 of 16 patients in the study who were not successfully engaged in care.
\u201cIt\u2019s important to look at how well everyone can use healthcare systems – some people may find it challenging and may end up with a lot of potentially preventable illness (and costs),\u201d N\u00ed Cheallaigh told\u00a0Contagion<\/em>\u00ae<\/sup>.
During the study period, 208 of 2063 patients had one or more unscheduled inpatient admissions. The 22 who had more than 30 days of cumulative hospital stays accounted for 1581 of 3380 HIV-related bed days (47%). Patients who had not been successfully engaged in HIV care showed consequences including organ failure, cancer and infection.
\u201cWe hope to look at alternative models of care (eg assertive outreach models of integrated health and social care) to see if these work better at keeping this type of patient healthier,\u201d N\u00ed Cheallaigh told\u00a0Contagion<\/em>\u00ae<\/sup>.
Recent efforts to combat HIV have focused on early intervention and retention in care. In the United States, it is estimated that 85% of people living with HIV have been diagnosed, 62% have received medical care, and 48% have been retained in care. A\u00a0recent study\u00a0examined rapid initiation of antiretroviral therapy, finding that starting ART on the day of a diagnosis or at the first appointment is safe, well tolerated, leads to earlier viral suppression, and may increase retention in care.
Another study looked at the benefits of\u00a0linking incarcerated people with HIV care\u00a0upon release from jail. These patients often have barriers to care such as mental illness, substance abuse and homelessness. Implementing programs with transitional care coordinators responsible for patient engagement and education could reengage individuals lost to care and link diagnosed people to treatment.<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":4616,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[3067,159,3066,3068,55],"class_list":["post-4615","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-aids-hiv","tag-costly","tag-hospital","tag-intervention","tag-leads","tag-patients"],"yoast_head":"\n