TY - JOUR
T1 - Insurance coverage, usual source of care, and receipt of clinically indicated care for comorbid conditions among adults living with human immunodeficiency virus
AU - Goldstein, Risë B.
AU - Rotheram-Borus, Mary Jane
AU - Johnson, Mallory O.
AU - Weinhardt, Lance S.
AU - Remien, Robert H.
AU - Lightfoot, Marguerita
AU - Catz, Sheryl L
AU - Gore-Felton, Cheryl
AU - Kirshenbaum, Sheri
AU - Morin, Stephen F.
PY - 2005/4
Y1 - 2005/4
N2 - Background and Objectives: Associations of insurance coverage and source of care with use of human immunodeficiency virus (HIV)-related health, mental health, and substance abuse services are examined in a large, diverse, highly active antiretroviral therapy-era cohort. Methods: Adults who were infected with HIV (n = 3818) were interviewed in clinics and community agencies in Los Angeles, Milwaukee, New York, and San Francisco regarding drug use behaviors, health status, and health care utilization. Results: Most participants were insured by Medicaid. During the previous 3 months, 90% of privately insured, 87% of publicly insured, and 78% of uninsured participants had visited any provider. Publicly and privately insured participants were similar in receipt of antiretrovirals, prophylaxis against Pneumocystis carinii pneumonia, substance abuse services, and antidepressants. Uninsured participants were less likely to receive antiretrovirals but were more likely to use substance abuse services. Participants with no usual source of care were less likely to receive PCP prophylaxis. Conclusions: A lack of insurance is associated with barriers to care, but the advantage of private over public coverage appears smaller than in previous studies. PCP prophylaxis, substance abuse treatment, and antidepressants remain markedly underutilized. Educational initiatives about these treatments targeting providers and patients are indicated.
AB - Background and Objectives: Associations of insurance coverage and source of care with use of human immunodeficiency virus (HIV)-related health, mental health, and substance abuse services are examined in a large, diverse, highly active antiretroviral therapy-era cohort. Methods: Adults who were infected with HIV (n = 3818) were interviewed in clinics and community agencies in Los Angeles, Milwaukee, New York, and San Francisco regarding drug use behaviors, health status, and health care utilization. Results: Most participants were insured by Medicaid. During the previous 3 months, 90% of privately insured, 87% of publicly insured, and 78% of uninsured participants had visited any provider. Publicly and privately insured participants were similar in receipt of antiretrovirals, prophylaxis against Pneumocystis carinii pneumonia, substance abuse services, and antidepressants. Uninsured participants were less likely to receive antiretrovirals but were more likely to use substance abuse services. Participants with no usual source of care were less likely to receive PCP prophylaxis. Conclusions: A lack of insurance is associated with barriers to care, but the advantage of private over public coverage appears smaller than in previous studies. PCP prophylaxis, substance abuse treatment, and antidepressants remain markedly underutilized. Educational initiatives about these treatments targeting providers and patients are indicated.
KW - Addiction treatment
KW - Antidepressants
KW - Antiretroviral therapy
KW - Comorbidity
KW - HIV
KW - Pneumocystis carinii pneumonia prophylaxis
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U2 - 10.1097/01.mlr.0000156850.86917.f8
DO - 10.1097/01.mlr.0000156850.86917.f8
M3 - Article
C2 - 15778643
AN - SCOPUS:20244371039
VL - 43
SP - 401
EP - 410
JO - Medical Care
JF - Medical Care
SN - 0025-7079
IS - 4
ER -