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Session 171 Poster Abstracts
Mental Health and Substance Abuse
Wednesday, 1:30 - 3:30 pm
Hall B


983
Hospital Services Utilization among HIV-infected Patients with Co-occurring Serious Mental Illness and Injection Drug Use Receiving Outpatient HIV Care
Seth Himelhoch*1, K Gebo2, G Chander2, and J Dilonardo3
1Univ of Maryland Sch of Med, Baltimore, USA; 2Johns Hopkins Univ Sch of Med, Baltimore, MD, USA; and 3Ctr for Substance Abuse Treatment, Rockville, MD, USA

Background:  Individuals with a co-occurring severe mental illness and injection drug use (IDU) are reported to have between 3 and 8 times the prevalence of HIV as the general population. These individuals are reported to have difficulties accessing high-quality medical services, which may place them at risk of utilizing inpatient medical services. We examined whether having a co-occurring severe mental illness and IDU impacts utilization of inpatient HIV-related health services as compared to those who have severe mental illness only, IDU only, or neither.

Methods:  Demographic, clinical, and resource utilization data were collected from medical records of 6181 patients in HIV primary care followed at 4 U.S. HIV primary and specialty care sites in different geographic regions with on-site mental health services in 2001. We analyzed the number of medical admissions and mean length of hospital stay using χ2 and logistic regression.

Results: The majority of the population was male (69.1%), of minority ethnicity, African American (41.0%) and Hispanic (24.4%), with a median age of 41 (range 18 to 91). Those with a co-occurring severe mental illness and IDU were significantly more likely to use inpatient medical services (χ2 = 160.4, p < 0.000) and use them more frequently (χ2 = 28.05, p < 0.000) than those who have severe mental illness only, IDU only, or neither (see the table). After adjusting for independent predictors including nadir CD4 count and HAART, those with a co-occurring severe mental illness and IDU had over 2.5 times the odds of being hospitalized (AOR 2.58; 95% CI 1.74 to 3.82) and nearly 3 times the odds of having > 1 hospitalization (2.93; 2.04 to 4.22) than those with neither severe mental illness nor IDU.

 

Any inpatient admission (%)

Of those hospitalized, % with > 1 admission

Mean length of inpatient hospital stay (days; 95% CI)

severe mental illness  & IDU (n = 318)

34.0

59.8

8.15; 6.12–10.17

severe mental illness only (n = 690)

24.1

38.5

6.19; 4.65–7.59

IDU only (n = 1571)

22.4

40.0

7.93; 6.12–10.17

Neither severe mental illness nor IDU (n = 3656)

14.4

38.6

7.14; 6.79–7.50

Conclusions:  Individuals with co-occurring severe mental illness and substance use disorders are significantly more likely to use HIV-related medical inpatient services even after adjusting for CD4 count and HAART. These services are expensive, and efforts should be targeted toward these populations to reduce potentially avoidable inpatient care.

 

Keywords: Serious Mental Illness; Substance Use; HIV Related Medical Hospitalizations