ACCESS TO COMMUNITY-BASED SERVICES SERVICES AND NUMBER OF HOSPITALIZATIONS AMONG PATIENTS WITH HIV DISEASE - ARE THEY RELATED

To assess whether better access to community-based outpatient medical services was associated with fewer HIV-related hospitalizations, we st udied 217 patients hospitalized at seven southern California hospitals . During hospital admission, patients completed an interview that incl uded one item about the reported difficulty or ease of access to commu nity-based medical services prior to their first hospitalization for H IV-related illness. After discharge, medical records were abstracted f or data on prior hospitalizations, CD4 counts, and illness severity. A bout one-half of patients reported that medical services were readily accessible. Medical records revealed that since the time of HIV infect ion 49% had had two or more total hospitalizations (mean = 2, SD = 2). In multiple logistic regression analysis, better reported access to s ervices was significantly associated with not having been hospitalized (vs. having been hospitalized) over the same time period (OR = 0.73, 95% CI = 0.55-0.97), controlling for CD4 count, illness severity, dura tion of diagnosed HN infection, having a regular source of care, type of hospital care, insurance coverage, and other patient characteristic s. Improving access to community-based medical services for ambulatory HIV-infected patients may help to avert costly hospital care. Prospec tive studies are needed to assess whether a causal relationship betwee n greater community-based access and reduced hospitalizations exists a nd, if so, whether community-based services may be cost-effective subs titutes for hospital HIV care.