CORRELATES OF MEDICAL-SERVICE UTILIZATION AMONG PEOPLE WITH HIV-INFECTION

Objective. To examine factors affecting the use of inpatient, outpatie nt, and emergency room services by people with HIV infection. Data Sou rces and Study Setting. Study participants are adults with HIV infecti on receiving services at major providers of medical care in ten U.S. c ities. Six interviews were conducted over an 18-month period (March 19 91 to September 1992). Data Collection Methods. Data on service utiliz ation, personal background characteristics, insurance status, and func tional status are based on self-report. Disease stage is based on medi cal record data. Study Design. This is an observational study using a panel survey design. Linear and Poisson regression analyses were condu cted to determine the effects of need, enabling, and predisposing fact ors on the dependent variables of ambulatory visits, emergency room vi sits, inpatient admissions, and average length of inpatient slay. Anal yses use 1,449 respondents who completed the second and third intervie ws. Independent variables were measured as of the second interview, wh ile dependent variables were measured in the third and fourth intervie w periods. Principal Findings. Service utilization was higher among re spondents with AIDS than among those at earlier stages of HIV infectio n. Functional limitations, experienced pain, and negative mood each we re associated with increased service use, over and above disease stage . Black respondents reported more hospital admissions and longer lengt hs of inpatient stays than white respondents. Lack of insurance was re lated to reduced service use. The effects of disease stage and functio nal limitations were reduced among people with public, compared to pri vate, insurance. Conclusions. While disease stage affects use of medic al care, the experience of adverse HIV-related conditions, such as pai n or functional limitations, has an additional effect on service use. Persistent racial differences in utilization remain to be explained. L ack of insurance impedes use directly and also modifies the effects of disease stage and functioning.