Missed Office Visits Increase Mortality After HIV Diagnosis

While patients who receive consistent care soon after HIV diagnosis experience improved clinical outcomes, the opposite is also true, as missed physician visits put patients at greater risk of early demise. In other words, the first year following diagnosis is a critical window in which clinicians need to engage patients. Thus, receiving appropriate antiretroviral medication and continuous assessment and care is a national goal for all HIV patients.

Many studies concerning poor care linkages have been conducted in indigent and uninsured populations. A team of investigators associated with Kaiser Permanente Northern California (KPNC) have a keen interest in this topic, as they currently provide care to more than 6,600 HIV-infected individuals. Although the vast majority of their patients engage in care within 90 days of diagnosis, KPNC would like to improve engagement among the most vulnerable patients who do not take an active role in their treatments. To that end, the researchers examined the relationship between missed visits and mortality in an insured cohort who were mostly employed.

The study population included 2,811 newly diagnosed HIV patients at least 18 years old between January 1997 and December 2009, and within that cohort, the researchers compared patients who missed visits in the first year after diagnosis to those who did not. Among the participants, 65 percent missed one or more visits, and 226 patients died during the study’s follow-up period.

Patients who were younger, from minority ethnicities, injection drug users, or presenting with lower CD4 levels were most likely to miss visits, and the increase in mortality risk for those patients was significant and high. In fact, each missed visit increased an HIV patient’s risk of death by 12 percent, and patients who missed one or more visits were 71 percent more likely to die.

While similar results have been seen globally, other research groups have reported a greater risk per missed visit. The investigators suggest that their lower risk rates reflect KPNC’s case management approach, integrated care model, and low rates of homelessness among their patient population.

The KPNC researchers urged physicians to stress visit adherence to newly diagnosed HIV patients, as each visit is an opportunity for those patients to receive immunizations, preventive health screenings, medication review, mental health assessment, and drug and alcohol abuse screening. More importantly, each visit allows physicians to track CD4 levels, a factor associated with increased longevity and better quality of life.