Failures in identifying early HIV infection, providing state-of-the-art treatment, and meeting the medical and non-medical needs of patients occur commonly among civilian providers across the United States. To improve the care of veterans with HIV/AIDS in the VA, the QUERI-HIV, of which this project is a part, aimed to build on these findings.
The goal of this study was to supplement the HIV Quality Enhancement Database (HIV-QED), a research-standard derivative of the Immunology Case Registry (ICR), with primary data collected from a sample of HIV-infected veterans for the purpose of providing comprehensive baseline information on their current care.
We conducted 35-minute telephone interviews with veterans in VA care for HIV/AIDS in CY 2001 after pretesting the survey instrument on 50 subjects. Instrument domains included satisfaction with care, unmet needs, functional status, adherence to medication regimens, health-related quality of life, and similar variables. Using the VA ICR as the sample frame, we selected a probability-proportional-to-size sample of facilities and then a random sample of veterans from each of the sampled facilities. Of the nearly 18,000 patients in the universe of 134 VA facilities that provide HIV-specific care, 2,500 patients in 47 facilities were targeted for recruitment. We anticipated a yield of 1,800 responses (or 10% of the universe), assuming a 70 percent response rate.
573 patients from 30 facilities completed interviews for an overall 23% response rate. Hospital HIV caseloads of all sizes were evenly represented (33.3% <200 HIV pts/yr, 33.2% 200-400 HIV pts/yr, 33.5% >400 HIV pts/yr). Respondents were primarily >50 yrs., male, African-American, at least high school educated, and had household incomes >$10,000. Preliminary findings reveal that respondents had lower general physical and mental health compared to national norms (SF-12 PCS=43.6, MCS=45.1) and 3 or > general co-morbid conditions (52%). 68% reported have at least one HIV-related co-morbidity; 48.2% had 1 or > days in bed due to health in previous 4 weeks and 27.8% reported no limitations in physical functioning. Regarding substance use, 11% had at least a strong indication of alcoholism (CAGE) but 75% reported no illegal drug use in previous 30 days; of the 25% who reported drug use, marijuana was the most commonly used substance. Analysis of non-response revealed significant differences between participating and nonparticipating sites and patients.
Data collected on these variables will help detect problems in care quality and health deficits; and identify areas for expanding services. Results will also help elucidate the problem of survey non-response.
- Asch SM, Kilbourne AM, Gifford AL, Burnam MA, Turner B, Shapiro MF, Bozzette SA. Underdiagnosis of depression in HIV: who are we missing? Journal of general internal medicine. 2003 Jun 1; 18(6):450-60.