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<title>Research Activities, October 1995: HIV/AIDS Research</title>
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<p><strong>You Are Here:</strong> <span class="crumb_link"><a href="/" class="crumb_link">AHRQ Archive Home</a> &gt; <a href="/research/resarch.htm" class="crumb_link"><em>Research Activities</em> Archive</a> &gt; <a href="." class="crumb_link">October 1995</a>
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<td><h1><a name="h1" id="h1"></a>HIV/AIDS Research </h1>
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<td><div id="centerContent"><div class="headnote">
<p>This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: <a href="https://info.ahrq.gov/">https://info.ahrq.gov</a>. Let us know the nature of the problem, the Web address of what you want, and your contact information. </p>
<p>Please go to <a href="https://www.ahrq.gov/">www.ahrq.gov</a> for current information.</p></div>
<a name="head1"></a><h2>Limited access to care affects quality of
life more than some
physical symptoms for poor HIV-infected persons</h2>
<p>Low-income persons infected with the human immunodeficiency virus
(HIV) who experience HIV-related symptoms such as fever,
diarrhea, or rapid weight loss have an urgent need for care. Yet,
they have a much more difficult time obtaining medical care than
others, and the struggle to obtain needed care may diminish their
quality of life more than their disease does, according to a
recent study that was supported in part by the Agency for Health
Care Policy and Research (HS06775).</p><p>
William E. Cunningham, M.D., M.P.H., of the University of
California, Los Angeles, and his colleagues compared the access
to care of 205 low-income adults infected with HIV at one public
and one Department of Veterans Affairs (VA) hospital with their
health-related quality of life (HRQOL). Over half of the patients
were Latino (28 percent) or black (26 percent). Findings showed
that worse overall access to care was strongly associated with
poorer HRQOL, even after controlling for CD4 count and symptoms.
HRQOL refers to current health perceptions, energy/fatigue,
freedom from pain, emotional well-being, ability to carry out
social functions, hopefulness, lack of loneliness, and so forth.
The overall quality-of-life score was 59.7 for those who
perceived high access to care compared with 44.5 for those who
perceived low access, a significantly larger effect than having a
fever in the preceding 2 weeks.</p>
<p>Problems with access to care for this group were widespread,
especially among the uninsured: 55 percent traveled for over 30
minutes to a usual source of care (compared with 9-12 percent of
the general population in national surveys); 49 percent had
difficulty paying for their care; and 38 percent had trouble
obtaining urgent care or emergency care (33 percent). These
findings add to previous ones showing that traditionally
disadvantaged groups, such as the poor, often face barriers to
therapy that could potentially reduce their symptoms and disease
progression.</p><p>
See "Access to medical care and health-related quality of life
for low-income persons with symptomatic human immunodeficiency
virus," by Dr. Cunningham, Ron D. Hays, Ph.D., Kevin W. Williams,
M.D., M.P.H., and others, which appears in <em>Medical Care</em> 33(7), pp. 739-754, 1995. </p>
<a name="head2"></a><h2>Satisfaction with outpatient AIDS care
differs among patient groups</h2>
<p>Blacks and injection drug users (IDUs) with acquired
immunodeficiency syndrome (AIDS) are twice as likely to rate the
quality of their outpatient care lower than other AIDS patients,
regardless of where they receive their care or the severity of
their illness. Women and Medicaid patients who have AIDS also are
apt to rate their quality of outpatient care lower. This suggests
that models of care which have proven useful for homosexual white
men, who were hit hardest by the initial wave of the AIDS
epidemic, need to be reassessed for their effectiveness and
relevance to minorities, IDUs, and women who are increasingly
being affected by AIDS, according to a study supported by the
Agency for Health Care Policy and Research (HS06239).</p><p>
Researchers at Boston University, Harvard Medical School, and
Brigham and Women's Hospital used patient surveys and medical
records of 305 patients at a public hospital AIDS clinic, an
academic group practice, and a staff-model health maintenance
organization (HMO) during 1990 and 1991 to examine the
relationship between patient characteristics and site of care to
patients' perceptions of outpatient care. They used a six-item
scale of patient-rated quality of care (PRQC) that combined
patients' ratings of the care received from physicians, nursing
care, involvement in medical decisions, and overall quality of
care.</p>
<p>The researchers found that black patients and IDUs were twice as
likely as other AIDS patients to rate their care in the lowest
quartile. This suggests that their care needs are not being met
as well as the needs of other patients. Nearly all of the
patients (97 percent) could identify a regular physician, but
only 55 percent could identify a regular nurse. Those who had a
regular nurse were half as likely to have low PRQC scores,
validating the important role of primary nursing in outpatient
AIDS care.</p><p>
See "Satisfaction with ambulatory care of persons with AIDS:
Predictors of patient ratings of quality," by Valerie E. Stone,
M.D., M.P.H., Joel S. Weissman, Ph.D., and Paul D. Cleary, Ph.D.,
in the <em>Journal of General Internal Medicine</em> 10, pp.
239-245, 1995.</p>
<p class="size2"><a href=".">Return to Contents</a><br />
<a href="dept6.htm">Proceed to Next Section</a></p>
<div class="footnote">
<p> The information on this page is archived and provided for reference purposes only.</p></div>
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