Effect of case management on unmet needs and utilization of medical care and medications among HIV-infected persons

Background: Although case management has been advocated as a method for imp roving the care of chronically ill persons, its effectiveness is poorly und erstood. Objective: To assess the effect of case managers on unmet need for supporti ve services and utilization of medical care and medications among HIV-Infec ted persons. Design: Baseline and follow-up interview of a national probability sample. Setting: Inpatient and outpatient medical facilities in the United States. Participants: 2437 HIV-infected adults representing 217 081 patients receiv ing medical care. Measurements: Outcomes measured at follow-up were unmet need for supportive services, medical care utilization (ambulatory visits, emergency departmen t visits, and hospitalizations), and use of HIV medication (receipt of anti retroviral therapy and prophylaxis against Pneumocystis carinii pneumonia a nd toxoplasmosis). Results: At baseline, 56.5% of the sample had contact with a case manager i n the previous 6 months. In multiple logistic regression analyses that adju sted for potential confounders, contact with a case manager at baseline was associated with decreased unmet need for income assistance (odds ratio [OR ], 0.57 [95% Cl, 0.36 to 0.91]), health insurance (OR, 0.54 [CI, 0.33 to 0. 89]), home health care (OR, 0.29 [Cl, 0.15 to 0.56]), and emotional counsel ing (OR, 0.62 [CI, 0.41 to 0.94]) at follow-up. Contact with case managers was not significantly associated with utilization of ambulatory care (OR, 0 .77 [Cl, 0.57 to 1.04]), hospitalization (OR, 1.13 [CI, 0.84 to 1.54]), or emergency department visits (OR, 1.30 [Cl, 0.97 to 1.73]) but was associate d with higher utilization of two-drug (OR, 1.58 (Cl, 1.23 to 2.03]) and thr ee-drug (OR, 1.34 [Cl, 1.00 to 1.80]) antiretroviral regimens and of treatm ent with protease inhibitors or non-nucleoside reverse transcriptase inhibi tors (OR, 1.29 [CI, 1.02 to 1.64]) at follow-up. Conclusions: case management appears to be associated with fewer unmet need s and higher use of HIV medications in patients receiving HIV treatment.