Palenicek JG, Flynn CP, Kass N, Graham NM, Saah AJ; International Conference on AIDS.
Int Conf AIDS. 1993 Jun 6-11; 9: 535 (abstract no. PO-B38-2397).
Dept. of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland.
PURPOSE: Describe and compare demographic characteristics, clinical-immunologic status, access to preventive medical therapies, and utilization of medical services among HIV-infected gay/bisexual men within the Multicenter AIDS Cohort Study (MACS) enrolled in HMOs as compared to traditional, FFS insurance plans. METHODS: A subgroup (N = 780) of the MACS has been used for this preliminary analysis. Study visit includes a standard questionnaire, blood work, and physical exam given during April 1-September 30, 1991. Chi-square, Fisher's exact and t-tests were used to test differences between patient groups. RESULTS: Our preliminary analysis revealed that HIV seronegative participants were significantly more likely to be enrolled in an HMO as compared to HIV seropositive men (26% vs 15%, respectively; p < .001). Within the 259 HIV-infected participants (85% FFS, 15% HMO), HMO members were more likely to be between the ages 35-44 (p = .008) and African American (p = .001). Employment status (FT/PT/unempl) and income were similar between groups. Frequency of reported HIV-related clinical symptoms were similar between groups; however, HMO enrollees were more likely to have higher CD4 cell counts (p = .043). Antiretroviral (AZT/ddI/ddC) use was more likely among FFS participants (p = .033), and further stratification by CD4 cell level continued to show a trend toward greater use among the FFS group with CD4 counts > 200/mm3. PCP prophylaxis use (AP/dapsone/TMP-SMX) displayed a similar trend in the FFS group, 28% vs 18% respectively. Utilization of outpatient medical services showed an increased proportion of users among the FFS group with an increased median frequency of visits. ER and inpatient hospital visits did not differ between groups. CONCLUSION: HMOs were less likely to be the source of primary medical care among HIV seropositive gay/bisexual men as compared HIV seronegative men. A trend toward greater access to antiretroviral therapy, PCP prophylaxis and utilization of outpatient services was seen among participants with FFS insurance plans. Planned analysis on the entire MACS cohort will further clarify these findings.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- African Americans
- Bisexuality
- CD4 Lymphocyte Count
- CD4-Positive T-Lymphocytes
- Fee-for-Service Plans
- HIV Infections
- HIV Seropositivity
- Health Maintenance Organizations
- Homosexuality
- Humans
- Income
- Male
- economics
Other ID:
UI: 102205417
From Meeting Abstracts