intellectual vanities… about close to everything

Personal Chaos In HIV Patients’ Lives May Be A Barrier To Regular Medical Care

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Pharmindustry lately seems to love funding research about bad HIV guys, who do not take their pills regularly. I assume, it is because those guys ruin the last bits of ROI that can be squeezed out of market in the Western world. That same industry is ways less interested in AIDS-related health issues in what is called the Third World. These studies do find out everytime so amazing things! This time we learn, that unstable and unpredictable lifestyles are significant factors in determining access to health care among low-income HIV-positive people, from a new UCLA study.

The study mirculously found that when HIV patients lead chaotic lives — meaning they are disorganized or experience too many unexpected events — that chaos can act as a barrier to regular medical care. The ingenious researchers even tailored a new scale to gauge the level of chaos in an adult’s life (in case you wanna try?).

The findings suggest a possible new alternative to help ensure that low-income patients get the care they need, said the study’s lead author, Dr. Mitchell Wong, an assistant professor of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. (The study also finds interesting odds concerning racial provenance among participants. But these were less likely to be leading to “new help alternatives” and hence are amiss in the discussion of results.)

“Many people have barriers to care, such as problems with transportation, housing, child care and health insurance. Traditionally, we look to solve these problems with case managers who can help reduce these barriers,” Wong said. “But there’s a whole potential other mechanism which might be happening — that people are just having trouble managing and organizing their lives. I think many of us take for granted the support mechanisms that we have, but many people who are living in poverty don’t have that support network. They don’t have that buffer zone to cope with the unexpected things. Perhaps enhancing stability and organization in people’s lives can also help them get the regular care that they need.”

Some 220 low-income HIV-positive patients participated in the study. Of those, 45 percent were African American, 40 percent were Latino and 20 percent were women. About one-third did not graduate from high school, approximately 75 percent had a history of homelessness and half had used drugs in the previous 30 days. In addition, 45 percent were uninsured and 75 percent had one or more unmet social-service need. In the six months prior to the study, 83 percent had seen a physician for HIV care at least twice, 46 percent missed two or more visits, and one-third had gone to a hospital emergency room at least once.

In developing the new scale to measure chaos in adults’ lives, the researchers took as their model the 15-item Confusion, Hubbub, and Order Scale (CHAOS), designed for parents to assess chaos affecting children’s home lives. The researchers changed some questions in the CHAOS scale to reflect a person’s life in general and whittled the assessment down to six simple statements designed to key in on the level of chaos in patients’ lives. These statements had a five-point response ranging from “strongly agree” to “strongly disagree.”

The statements were:

  • My life is organized.
  • My life is unstable.
  • My routine is the same from week to week.
  • My daily activities from week to week are unpredictable.
  • Keeping a schedule is difficult for me.
  • I do not like to make appointments too far in advance because I do not know what might come up.

The researchers found that those patients who did not have spouses or partners and those with at least one unmet social-service need, such as transportation or housing, scored highest on the chaos scale.

They also found that patients with more chaos in their lives were less likely to have had two or more outpatient HIV care visits and were more likely to have missed two or more visits in the six months prior to enrolling in the study. These patients also had lower mental health status, both when they enrolled in the survey and at follow-up. The researchers, however, did not find an association between life chaos and emergency department visits or physical health status.

The Health Resources and Services Administration, the National Institute on Aging, the Pfizer Foundation, the National Center on Minority Health and Health Disparities, and the National Institute of Mental Health funded the study.

J Gen Intern Med. 2007 Sep;22(9):1286-91. Epub 2007 Jun 28.

The association between life chaos, health care use, and health status among HIV-infected persons.

Wong MD, Sarkisian CA, Davis C, Kinsler J, Cunningham WE.

UCLA Division of General Internal Medicine and Health Services Research, University of California, 911 Broxton Avenue, Suite 101, Los Angeles, CA 90024, USA. mitchellwong@mednet.ucla.edu

BACKGROUND: Whether having a stable and predictable lifestyle is associated with health care use and health status among HIV patients is unknown. OBJECTIVE: To develop and test the reliability and validity of a measure of life chaos for adults with HIV and examine its association with health care use and health status. DESIGN: Prospective cohort study. PARTICIPANTS: Two hundred twenty HIV-infected persons recruited from those who tested positive in a mobile testing van and from HIV clinics serving low-income populations. MEASUREMENTS: Participants completed a survey every 6 months, assessing their health care use, SF-12 mental and physical health status and life chaos. RESULTS: Cronbach’s alpha for the six-item measure of chaos was .67. Those without a spouse or partner and those with one or more unmet social service needs, such as housing or transportation, had higher chaos scores. Compared to those with less chaos, those with more chaos were less likely to have two or more outpatient visits (adjusted odds ratio [OR] 0.48, 95% confidence interval [CI]: 0.24-0.98), more likely to have two or more missed visits (adjusted OR 2.30, 95%CI: 1.20-4.41) in the 6 months before study enrollment and had lower mental health status at enrollment and at follow-up. Life chaos was not associated with emergency department visits or physical health status. CONCLUSIONS: We created a new measure of life chaos, which was associated with outpatient visits and mental health status. Chaos may be an important barrier to regular medical care. Future studies need to test this measure in more diverse populations and those with other diseases.

Written by huehueteotl

September 12, 2007 at 11:21 am

Posted in HIV, what I read

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