Frequent Emergency Department Use Among Released Prisoners With Human Immunodeficiency Virus: Characterization Including a Novel Multimorbidity Index

Authors

  • Jaimie P. Meyer MD,

    Corresponding author
    1. Divisions of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT
    • Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT
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  • Jingjun Qiu MD, MS,

    1. Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT
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  • Nadine E. Chen MD, MPH,

    1. Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT
    2. Department of Medicine, Division of Global Public Health, University of California San Diego School of Medicine, University of California San Diego School of Medicine, San Diego, CA
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  • Gregory L. Larkin MD, MSPH, MS,

    1. Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
    2. Department of Surgery, Division of Emergency Medicine, University of Auckland School of Medicine, Auckland, NZ
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  • Frederick L. Altice MD, MA

    1. Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT
    2. Division of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT
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  • Primary funding for this research was provided by the National Institute on Drug Abuse (R01 DA017059, FLA). The authors also acknowledge career development funding from the National Institutes of Allergy and Infectious Diseases (T32 AI007517 for JPM), the National Institute of Mental Health (T32 MH020031 for JPM), the National Institute on Drug Abuse (K24 DA017072 for FLA and K23 DA033858 for JPM), and the American Foundation for Suicide Prevention (Distinguished Investigator Award for GLL). The authors have no further disclosures or conflicts of interest to report.

Address for correspondence and reprints: Jaimie P. Meyer, MD; e-mail: jaimie.meyer@yale.edu.

Abstract

Objectives

The objective was to characterize the medical, social, and psychiatric correlates of frequent emergency department (ED) use among released prisoners with human immunodeficiency virus (HIV).

Methods

Data on all ED visits by 151 released prisoners with HIV on antiretroviral therapy (ART) were prospectively collected for 12 months. Correlates of frequent ED use, defined as having two or more ED visits postrelease, were described using univariate and multivariate models and generated medical, psychiatric, and social multimorbidity indices.

Results

Forty-four (29%) of the 151 participants were defined as frequent ED users, accounting for 81% of the 227 ED visits. Frequent ED users were more likely than infrequent or nonusers to be female; have chronic medical illnesses that included seizures, asthma, and migraines; and have worse physical health-related quality of life (HRQoL). In multivariate Poisson regression models, frequent ED use was associated with lower physical HRQoL (odds ratio [OR] = 0.95, p = 0.02) and having not had prerelease discharge planning (OR = 3.16, p = 0.04). Frequent ED use was positively correlated with increasing psychiatric multimorbidity index values.

Conclusions

Among released prisoners with HIV, frequent ED use is driven primarily by extensive comorbid medical and psychiatric illness. Frequent ED users were also less likely to have received prerelease discharge planning, suggesting missed opportunities for seamless linkages to care.

Resumen: La Hiperfrecuentación al Servicio de Urgencias de los Presos Puestos en Libertad con VIH: Caracterización que Incluye un Índice de Multimorbilidad Novedoso

Objectivos

Caracterizar la correlación médica, social y psiquiátrica de la hiperfrecuentación al servicio de urgencias (SU) de los presos puestos en libertad con VIH.

Método

Se recogieron de forma prospectiva los datos de todas las visitas al SU de 151 presos en libertad con VIH en tratamiento antirretroviral durante 12 meses. La correlación de la hiperfrecuentación al SU, definida como haber tenido dos o más consultas al SU tras su libertad, se describió usando modelos univariables y multivariables, y se generaron indices multimorbilidad social, psiquiátrica y médica.

Resultados

Cuarenta y cuatro (29%) de los 151 participantes se definieron como hiperfrecuentadores del SU, lo que suponia el 81% de las 227 visitas al SU. Los hiperfrecuentadores tuvieron mayor probabilidad que los no frecuentadores o no usuarios de ser mujer, tener enfermedades médicas crónicas (que incluyeron epilepsia, asma y migraña) y peor calidad de vida relacionada con la salud. En el análisis multivariable mediante modelos de regresión de Poisson, los hiperfrecuentadores se asociaron con una peor calidad de vida relacionada con la salud (odds ratio [OR] 0,95, p = 0,02) y con no haber tenido un plan antes de la libertad (OR 3.16, p = 0.04). Los hiperfrecuentadores del SU se correlacionaron positivamente con valores elevados de multimorbilidad psiquiátrica.

Conclusiones

Entre los presos liberados con VIH, la hiperfrecuentación del SU está condicionada principalmente por una amplia comorbilidad médica y enfermedad psiquiátrica. Los hiperfrecuentadores del SU tienen también menos probabilidad de tener un plan antes de la liberación, lo que sugiere una pérdida de oportunidades para la continuidad en la atención.

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