Impact of Case Management for HIV-Infected Persons

Katz MH, Cunningham WE, Fleishman JA, Andersen R, Kellogg T, Bozzette SA, Shapiro MF. Impact of Case Management for HIV-Infected Persons. Paper presented at: Society of General Internal Medicine Annual Meeting; 2000 May 1; Boston, MA.

PURPOSE: Although case management has been advocated as a method for improving the care of HIV-infected persons, its effectiveness is poorly understood. We evaluated the impact of case managers on unmet need for supportive services, medical service utilization, and medication utilization among a population based sample of 2,445 HIV-infected adults receiving medical care in the United States (HCSUS study). METHODS: The HCSUS study employed a multistage design in which geographical areas, medical providers, and patients were chosen. In this analysis, case management and potential confounders (gender, age, ethnicity, HIV risk group, education, region, drug dependence, income, insurance status, housing status, living alone, sum of needs, and CD4 count) were assessed at baseline and outcomes were measured at the first follow-up visit (median duration between interviews was 8 months). RESULTS: At baseline, 57% of the sample had contact with a case manager in the prior six months. In multiple logistic regression analysis, adjusting for potential confounders, having contact with a case manager at baseline was associated with decreased unmet need for income assistance (OR = 0.45; 95% CI = 0.31-0.65), health insurance (OR = 0.60; 95% CI = 0.36-0.99), home care (OR = 0.30; 95% CI = 0.16-0.58), emotional counseling (OR = 0.63; 95% CI = 0.41-0.96) and any unmet need (OR = 0.46; 95% CI = 0.33-0.66) at follow-up. Contact with case managers was not associated with utilization of ambulatory care (OR = 0.87; 95% CI = 0.65-1.15), emergency care (OR = 1.27; 95% CI = 0.97-1.68), or hospitalization (OR = 1.09; 95% CI = 0.81-1.47). Contact with case managers was associated with higher utilization of two (OR = 1.58; 95% CI = 1.23-2.03) and three drug antiretroviral treatment (OR = 1.34; 95% CI = 1.00-1.78) as well as treatment with protease inhibitors and non-nucleoside reverse transcriptase inhibitors (OR = 1.26; 95% CI = 1.01-1.58) at follow-up. Contact with case managers was not associated with receipt of prophylaxis against Pneumocystis carinii pneumonia and toxoplasmosis (OR = 1.15; 95% CI = 0.83-1.60). CONCLUSION: Providing case management services to persons with HIV infection appears to decrease their unmet needs for supportive services and improve their medical care.