REPEATED EMERGENCY DEPARTMENT USE BY HIV-INFECTED PERSONS - EFFECT OFCLINIC ACCESSIBILITY AND EXPERTISE IN HIV CARE

Repeated emergency department (ED) visits by HIV-infected persons may signify poor access to care or treatment from inexperienced ambulatory providers. We examined features of 157 clinics following 6820 HIV-inf ected patients and associations with repeated (greater than or equal t o 2) ED visits by these patients in the year before their first AIDS d iagnosis. Patient clinical and health care data came from 1987-1992 Ne w York State (NYS) Medicaid files and clinic data came from interviews of clinic directors. The HIV/AIDS experience of each study patient's clinic was measured as the annual number of Medicaid enrollees newly d iagnosed with AIDS who were contemporaneously followed by the patient' s clinic. Repeated ED use was observed for 24%. The adjusted odds rati o (AOR) of repeated ED visits was reduced for patients in clinics with a physician on-call (0.77; 95% confidence interval [CI] = 0.65, 0.92) , evening or weekend clinic hours (0.77; 95% CI = 0.64, 0.93), or >50 AIDS patients/year in 1987-1988 (0.56; 95% CI = 0.44, 0.71) versus few er patients in those years. Patients in clinics with more than one fea ture promoting accessibility or HN expertise had a greater reduction i n their AOR of repeated ED use. HIV-infected patients in clinics with greater accessibility and HIV expertise rely less on the ED for care.