Association of ancillary services with primary care utilization and retention for patients with HIV/AIDS

Fenway Community Health Center (FCHC), located in Boston, Massachusetts, provides comprehensive care to persons with HIV/AIDS, including medical, mental health and other health-related services. In this paper, we present results from an analysis of existing data about the demographic and clinical characteristics, service needs and utilization patterns, and primary care retention of HIV-positive primary care patients seen at FCHC during a 24-month study period. Patient data were extracted from Logician, FCHC's electronic medical record system, and imported into Microsoft Access, Microsoft Excel and SAS for manipulation and analysis. A total of 999 unique individuals were included in the study population. Most were men (97%), white (75%) and between 39 and 80 years of age. Patients averaged 6.7 medical visits annually at FCHC, and 61% had at least one medical visit every six months. Significant predictors of primary care utilization were insurance status, HIV disease stage, being on combination therapy, first CD4 count, first viral load level and receipt of ancillary services. Need and receipt of ancillary services were found through medical and case management record review; case management was the most used ancillary service, received by 36% of the study population. For most ancillary services, clients with assessed need had documented receipt of the service. Publicly insured and/or Ryan White CARE Act-funded patients had the greatest ancillary service utilization. The influence of ancillary services upon primary care entry could not be evaluated with available data; however, their influence upon primary care was significant. For patients who received primary care in every continuous six-month period, statistically significant associations were found with receipt of mental health care, case management, drug assistance, food/nutrition, complementary services and housing. Using the more rigorous FCHC standard of care (minimum of four primary care visits per year), significant associations were also found with transportation, legal services and substance abuse treatment. For non-whites and women, mental health care, food/nutrition, housing and transportation had particular significance.