TY - JOUR
T1 - Missed visits and decline in CD4 cell count among HIV-infected patients
T2 - A mixed method study
AU - Walburn, Anna
AU - Swindells, Susan
AU - Fisher, Christopher
AU - High, Robin
AU - Islam, K. M.
PY - 2012/11
Y1 - 2012/11
N2 - Objective: To determine the impact of missed visits on CD4 cell count with HIV disease in a Midwest clinic. Methods: This was a mixed method study consisting of a quantitative retrospective cohort study of missed clinic visits among HIV-infected patients, and a qualitative study to collect information on factors impacting appointment attendance. A drop in CD4 cell count greater than 50 cells/mm3 from baseline was the primary outcome variable for the quantitative study. The exposure variable was missed visits. Results: Of 77 patients, 16.4% experienced the outcome of interest. Lower visit proportions increased the risk of a CD4 drop (hazard ratio 0.0188, 95% confidence interval 0.001-0.292). For each 10% increase in the missed visit proportion, the risk of a CD4 drop of >50 cells/mm3 from baseline increased by 33%. Qualitative data suggested that stigma, external support, and physician-patient interactions impacted engagement in care. Conclusion: These results may help providers increase patient motivation and ability to attend clinic appointments.
AB - Objective: To determine the impact of missed visits on CD4 cell count with HIV disease in a Midwest clinic. Methods: This was a mixed method study consisting of a quantitative retrospective cohort study of missed clinic visits among HIV-infected patients, and a qualitative study to collect information on factors impacting appointment attendance. A drop in CD4 cell count greater than 50 cells/mm3 from baseline was the primary outcome variable for the quantitative study. The exposure variable was missed visits. Results: Of 77 patients, 16.4% experienced the outcome of interest. Lower visit proportions increased the risk of a CD4 drop (hazard ratio 0.0188, 95% confidence interval 0.001-0.292). For each 10% increase in the missed visit proportion, the risk of a CD4 drop of >50 cells/mm3 from baseline increased by 33%. Qualitative data suggested that stigma, external support, and physician-patient interactions impacted engagement in care. Conclusion: These results may help providers increase patient motivation and ability to attend clinic appointments.
KW - CD4 count
KW - HIV infection
KW - Missed visits
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U2 - 10.1016/j.ijid.2012.06.004
DO - 10.1016/j.ijid.2012.06.004
M3 - Article
C2 - 22902645
AN - SCOPUS:84868196920
SN - 1201-9712
VL - 16
SP - e779-e785
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
IS - 11
ER -