Effect of enhanced prenatal and HIV-focused services for pregnant women who are infected by human immunodeficiency virus on emergency department use

OBJECTIVES. This study examines whether the receipt of enhanced prenatal or human immunodefiency virus (HIV) medical services is associated with in-pr egnancy emergency department (ED) utilization by HIV-infected women. METHODS. Medicaid and vital statistics records were linked for 1,826 women who are infected by HIV and who were delivered from 1993 to 1995 while rece iving New York State Medicaid. The authors examined two types of ambulatory care- the Prenatal Cdte Assistance Program (PCAP) and enhanced care focuse d on HIV- that offer additional services in exchange for increased Medicaid reimbursement. From logistic regression models, the authors estimated adju sted associations of these types of care with ED use during pregnancy not l eading directly to hospitalization. RESULTS. Fifty-three percent of pregnant women visited the ED. Women with E D use averaged 2.0 visits (SD = I,I), After adjustment for demographic and substance use factors, enhanced care focused on HIV was not associated with any ED use (On = 1.11, 95% CI 0.94, 1.30) or,among those using the ED at l east once, with number of visits (II = 0.84). Interactions of receipt of PC AP care with the Adequacy of:Prenatal Care Utilization Index (APNCU) and ha ving a usual source of care in pregnancy improved model fit (P < 0.001 and P = 0.06, respectively). PCAP was associated with increased ED use only amo ng women with inadequate APNCU or no usual. source of prenatal care. CONCLUSION. Pregnant women infected with HIV receiving Medicaid relied heav ily on ED care. Use of: the ED was not associated with services focused on HIV but was positively associated with enhanced prenatal care. The associat ion of enhanced prenatal care with greater ED use was curbed for women with more timely and adequate prenatal care visits or a usual source of prenata l care.