HOSPITAL AND HOSPICE RESOURCE USE OF HIV-POSITIVE PATIENTS IN EDINBURGH

A prospective study of health service and hospice resource utilization (average length of stay or ALOS, discharge rate, bed day use, outpati ent consultation) analysed with reference to gender, risk activity, im munological and clinical staging (1987 definition of AIDS) for the fin ancial year 1992-93 was undertaken at the Regional Infectious Disease Unit (RIDU), City Hospital, Edinburgh, Scotland where 72% of 513 patie nts were infected via injection drug use. Not surprising therefore ove rall, drug users were the heaviest users of the inpatient facilities ( 74% of the discharges and 65% of the bed days) although homosexuals ha d the highest discharge rate (114 per 100 person years) and rate of be d day use (1654 days per 100 person years). Immunodeficiency (CD4 coun t < 200 cells/ul) and a clinical diagnosis of AIDS were both associate d with greater inpatient and outpatient resource use compared to those without immunodeficiency (CD4 count greater than or equal to 200 CD4 cells/ul) or AIDS. Gender effects were complex; the ALOS for women was increased for all risk groups whatever the CD4 count whilst there was no consistent trend of more resource use for women by risk group. Dru g users were the heaviest overall users of the local hospice (84% of a ll admissions, 83% of the bed days and a discharge rate of 76.4 per 10 0 person years), more than double the rates experienced by the other r isk groups. Thus both clinical and immunological staging (AIDS or a CD 4: count < 200 cells/ul) were associated with increased resource use i n HIV infection and estimates of resource use for BIDS need to be incr eased by around one-third to take into account hospice use. Despite th e preponderance of drug users in Edinburgh, comparisons with other cen tres did not reveal increased resource use.