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Ontario Study Finds High Rate of Emergency Room Usage Among Some People With HIV

August 9, 2016

Studies have found that some people who do not have access to primary healthcare may resort to using the Emergency Room (ER) of their local hospital for care that is not urgent. It is important that health authorities understand how and why ERs are being used. Excessive use of ERs may indicate that there are gaps in primary healthcare that need to be addressed.

Researchers in Ontario reviewed health-related information from people that had been collected in databases. They found that, on average, HIV-positive people were more likely to use the ER, particularly for reasons relating to infections and mental health issues. However, the researchers said that some of the visits for non-urgent care by HIV-positive people could potentially have been dealt with in other care settings.


Study Details

Researchers analysed data from 14,534 HIV-positive adults that had been collected between April 2011 and March 2102. Data from each HIV-positive person was compared to that from four randomly selected HIV-negative people of similar age, geographic location and gender. In total, data from 58,136 HIV-negative people were used.

In this study, overall, people were on average 46 years old, 80% were men and 20% were women. HIV-positive people were likely to have co-existing health conditions, including breathing problems (chronic obstructive pulmonary disease, or COPD), and lower incomes than HIV-negative people.


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Results

During the study, 28% of HIV-positive people visited an ER compared to 18% of HIV-negative people.

According to the researchers, HIV-positive people had "high rates of ER visits related to" the following:

  • infectious diseases (most commonly related to skin and soft tissue infections)
  • mental health issues (most commonly related to "alcohol and substance use")

The researchers stated: "Although higher rates of infectious-disease-related visits among people with HIV are not unexpected, only a minority of visits were related to underlying HIV infection. In contrast, skin and soft-tissue infections accounted for most of these episodes in people with HIV, possibly reflecting complications of injection drug use among susceptible individuals."


In the United States

A large study from the U.S. focusing on the years 2009 and 2010 estimated that there were more than 200 million visits to the ER. Researchers found that HIV-positive people made only about 0.5% of such visits in that time. However, HIV-positive people were more likely to have visited the ER than HIV-negative people. While there were many reasons that HIV-positive people sought care, researchers found that they were more likely to seek care because of mental health issues.


In British Columbia

The findings from the Ontario study are somewhat similar to those from a study in British Columbia with people who injected street drugs. Researchers with the B.C. study reported that skin and soft tissue infections "accounted for the greatest proportion of ER visits."


Next Steps

In reviewing their own findings, the Ontario team added: "Further research is warranted to examine whether community-based interventions that promote access to outpatient-based mental health care, substance use treatment, oral health care and timely primary care could reduce potentially preventable ER visits among people with HIV."


Resource

Pre-fix: A guide for people with Hep C or HIV who inject drugs


References

  1. Ng R, Kendall CE, Burchell AN, et al. Emergency department use by people with HIV in Ontario: a population-based cohort study. CMAJ Open. 2016 May 25;4(2):E240-8. Available from: http://cmajopen.ca/content/4/2/E240.full.
  2. Mohareb AM, Rothman RE, Hsieh YH. Emergency department (ED) utilization by HIV-infected ED patients in the United States in 2009 and 2010 -- a national estimation. HIV Medicine. 2013 Nov;14(10):605-13. Available from: http://onlinelibrary.wiley.com/doi/10.1111/hiv.12052/full
  3. Fairbairn N, Milloy MJ, Zhang R, et al. Emergency department utilization among a cohort of HIV-positive injecting drug users in a Canadian setting. The Journal of Emergency Medicine. 2012 Aug;43(2):236-43.



This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication CATIE News. Visit CATIE's Web site to find out more about their activities, publications and services.
 

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