AEGiS-14IAC: System barriers to HIV Medical Care Appointment Compliance: Results of the ARTAS study.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

System barriers to HIV Medical Care Appointment Compliance: Results of the ARTAS study.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. G12519)

Wohler-Torres BA, Valverde EE, Anderson-Mahoney P, Barragan M, Loughlin A, Metsch LR
University of Miami - School of Medicine, Miami, United States

BACKGROUND: Adherence to medical appointments is important to the management of HIV disease. Missed appointments have been shown to be associated with negative clinical outcomes such as inability to suppress HIV-1 RNA levels. Although adherence is a multifaceted problem few studies have assessed the effect of system barriers on medical appointment compliance. The ARTAS Site survey provides a unique opportunity to explore whether certain types of clinic characteristics and services are related to patients' abilities to keep appointments.

METHODS: The Antiretroviral Treatment and Access Studies (ARTAS) included a mail survey of 138 HIV treatment facilities in four US cities (Atlanta, Baltimore, Los Angeles, and Miami). The survey was completed by clinic administrators, and gathered information on clinic staffing, hours of operation, clinic services and patient attendance. Chi-Square analysis and logistic regression analysis were used to estimate the association between missing appointments and a number of site characteristics.

RESULTS: An examination of "percent of HIV + patients missing scheduled appointment on any given day" indicates that over half of the clinics report that 11 - 75% of their patients miss their scheduled appointments on any given day. Our findings indicate clinics with less than 4 providers (OR= .3), and that offer mental health services (OR=.3) have fewer patients missing appointments. Alternatively, clinics providing Medicaid assistance (OR=7.3) and those clinics with more than 10% uninsured (OR=3.7) were more likely to have the majority of their patients missing scheduled appointments.

CONCLUSION: Smaller clinics may offer more personalized attention leading to higher rates of appointment compliance. Availability of mental health services also seem to be an incentive for patients to keep their appointments. On the other hand, uninsured patients have a higher risk of noncompliance to medical appointments.

Keywords: AEGIS, Appointments and Schedules, Patient Compliance, HIV Infections, HIV Seropositivity, Reproductive Health Services, Treatment Refusal, Community Health Services, Community Health Centers, Medically Uninsured, Data Collection, Outpatient Clinics, Hospital, Ambulatory Care Facilities, Los Angeles, Baltimore, Human

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