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Effect of Case Managers on the Care of Patients with HIV Infection
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What is the problem and what is known about it so far?
Case managers, who are often nurses or social workers, help patients coordinate their health care and related needs. Case managers often work with patients infected with HIV, the virus that causes AIDS. It is thought that case managers improve health outcomes for HIV-infected patients. However, few studies have looked at whether HIV-infected patients with case managers actually do better than those without case managers.
Why did the researchers do this particular study?
To find out whether HIV-infected patients with case managers are more likely than those without case managers to have their needs met.
Who was studied?
2437 HIV-infected adults who were participating in a national study of HIV-related health care.
How was the study done?
The researchers interviewed patients at the beginning of the study and asked whether they had seen or spoken to a case manager at least once during the previous 6 months. They also asked patients whether they were in need of any of six services: income assistance, health insurance, housing, home health care, emotional counseling, or drug abuse care. During a second interview (an average of 243 days after the first interview), they asked study patients about the same needs. The researchers defined a patient as having “unmet needs” if he or she reported needing at least one of the six services during the first interview and the need was not met by the time of the second interview. The researchers also asked patients about hospitalizations, emergency room visits, outpatient visits, and use of anti-HIV medicines between the first and second interviews. The researchers then compared unmet needs, health care use, and medication use between patients who had a case manager and those who did not.
What did the researchers find?
Just over half of the patients had a case manager. Having a case manager was associated with fewer unmet needs for income assistance, health insurance, home care, and emotional counseling at the time of the second interview. Compared to patients with no case manager, patients with a case manager were more likely to use anti-HIV drugs, but they were no more likely to have outpatient visits, hospitalizations, or emergency room visits.
What were the limitations of the study?
Patients with a case manager may differ from patients without one in ways that the researchers could not account for, so the study does not prove that case managers decrease unmet needs. Nationally, there is a wide range of case management services available; it is unclear what features of case management for HIV-infected persons led to the better outcomes seen in this study.
What are the implications of the study?
Case managers may help meet the needs of patients with HIV infection.
Article and Author Information
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The summary below is from the full report titled “Effect of Case Management on Unmet Needs and Utilization of Medical Care and Medications among HIV-Infected Persons.” It is in the 16 October 2001 issue of Annals of Internal Medicine (volume 135, pages 557-565). The authors are MH Katz, WE Cunningham, JA Fleishman, RM Andersen, T Kellogg, SA Bozzette, and MF Shapiro.
- Copyright ©2004 by the American College of Physicians
