Access to HAART and utilization of inpatient medical hospital services among HIV-infected patients with co-occurring serious mental illness and injection drug use

Seth Himelhoch, Geetanjali Chander, John A. Fleishman, James Hellinger, Paul Gaist, Kelly Gebo

Research output: Contribution to journalArticle

Abstract

Objective: Among HIV-infected individuals, we examined whether having co-occurring serious mental illness (SMI) and injection drug use (IDU) impacts: (a) receipt of highly active antiretroviral therapy (HAART), and (b) utilization of inpatient HIV services, compared to those who have SMI only, IDU only or neither SMI nor IDU. Method: Demographic, clinical and resource utilization data were collected from medical records of 5119 patients in HIV primary care at four US HIV care sites in different geographic regions with on-site mental health services in 2001. We analyzed receipt of HAART using multivariate logistic regression and the number of medical hospital admissions using multivariate logistic and Poisson regression analyses, which controlled for demographic factors, receipt of HAART, CD4 count and HIV-1 RNA. Results: Those with co-occurring SMI and IDU [adjusted odds ratio (AOR)=0.52; 95% confidence interval (95% CI)=0.41-0.81] and those with IDU alone (AOR=0.64; 95% CI=0.58-0.85) were significantly less likely to receive HAART than those with neither SMI nor IDU, controlling for demographic and clinical factors. Those with co-occurring SMI and IDU were more likely to use any inpatient medical services (AOR=2.22; 95% CI=1.64-3.01) and were significantly more likely to use them more frequently (incidence rate ratio=1.33; 95% CI=1.13-1.55) than those with neither SMI nor IDU, SMI only or IDU only. Conclusion: HIV-infected individuals with co-occurring SMI and IDU are significantly more likely to utilize HIV-related medical inpatient services than individuals with no comorbidity or with only one comorbidity. Individuals with both SMI and IDU did not differ from those with IDU only in receipt of HAART. Inpatient hospitalizations are expensive, and efforts should be targeted towards these populations to reduce potentially avoidable inpatient care.

Original languageEnglish (US)
Pages (from-to)518-525
Number of pages8
JournalGeneral Hospital Psychiatry
Volume29
Issue number6
DOIs
StatePublished - Nov 2007

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Highly Active Antiretroviral Therapy
Inpatients
HIV
Injections
Pharmaceutical Preparations
Confidence Intervals
Odds Ratio
Demography
Comorbidity
Logistic Models
Mental Health Services
CD4 Lymphocyte Count
Medical Records
HIV-1
Primary Health Care
Hospitalization
Regression Analysis
RNA

Keywords

  • HAART
  • HIV-infected patients
  • Inpatient medical hospital services

ASJC Scopus subject areas

  • Emergency Medicine
  • Medicine(all)
  • Psychiatry and Mental health

Cite this

Access to HAART and utilization of inpatient medical hospital services among HIV-infected patients with co-occurring serious mental illness and injection drug use. / Himelhoch, Seth; Chander, Geetanjali; Fleishman, John A.; Hellinger, James; Gaist, Paul; Gebo, Kelly.

In: General Hospital Psychiatry, Vol. 29, No. 6, 11.2007, p. 518-525.

Research output: Contribution to journalArticle

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abstract = "Objective: Among HIV-infected individuals, we examined whether having co-occurring serious mental illness (SMI) and injection drug use (IDU) impacts: (a) receipt of highly active antiretroviral therapy (HAART), and (b) utilization of inpatient HIV services, compared to those who have SMI only, IDU only or neither SMI nor IDU. Method: Demographic, clinical and resource utilization data were collected from medical records of 5119 patients in HIV primary care at four US HIV care sites in different geographic regions with on-site mental health services in 2001. We analyzed receipt of HAART using multivariate logistic regression and the number of medical hospital admissions using multivariate logistic and Poisson regression analyses, which controlled for demographic factors, receipt of HAART, CD4 count and HIV-1 RNA. Results: Those with co-occurring SMI and IDU [adjusted odds ratio (AOR)=0.52; 95{\%} confidence interval (95{\%} CI)=0.41-0.81] and those with IDU alone (AOR=0.64; 95{\%} CI=0.58-0.85) were significantly less likely to receive HAART than those with neither SMI nor IDU, controlling for demographic and clinical factors. Those with co-occurring SMI and IDU were more likely to use any inpatient medical services (AOR=2.22; 95{\%} CI=1.64-3.01) and were significantly more likely to use them more frequently (incidence rate ratio=1.33; 95{\%} CI=1.13-1.55) than those with neither SMI nor IDU, SMI only or IDU only. Conclusion: HIV-infected individuals with co-occurring SMI and IDU are significantly more likely to utilize HIV-related medical inpatient services than individuals with no comorbidity or with only one comorbidity. Individuals with both SMI and IDU did not differ from those with IDU only in receipt of HAART. Inpatient hospitalizations are expensive, and efforts should be targeted towards these populations to reduce potentially avoidable inpatient care.",
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AU - Hellinger, James

AU - Gaist, Paul

AU - Gebo, Kelly

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