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Risk scores, black race linked to missing visits with HIV providers
PHILADELPHIA — Black race and a higher risk for virologic failure were associated with missing visits with health care providers among people with HIV, according to data presented at IDWeek 2014.
Beverly Woodward, MSN, RN, of the clinical pharmacy services team at Vanderbilt Comprehensive Care Clinic, and colleagues conducted an observational cohort study from August 2013 to March 2014. The cohort included 510 patients who had viral loads of more than 200 copies/mL and routine visits scheduled. Using data from electronic health records, the researchers calculated the risk for virologic failure using a risk prediction tool (RPT) and estimated the odds of missing the next appointment.
The RPT score was calculated based on seven factors: poor medication adherence, poor clinic attendance, substance abuse, low CD4 count, heavy ART exposure, prior treatment failure and unsuppressed viremia. Patients were considered medium risk if they had two or three of these risk factors and high risk if they had four or more.
The median age of patients was 39 years, 74% were men and 55% were black. The median CD4 count was 332 cells/mcL and the median viral load was 21,540 copies/mL.
Age, male sex, year of entry into the cohort, CD4 count and HIV viral load were not associated with increased odds for missing the next appointment. Black race was independently associated with increased odds for missing the next appointment (OR=2.39; 95% CI, 1.59-3.60), as was a medium RPT score (OR=3.96; 95% CI, 2.16-7.23) and high RPT score (OR=9.53; 95% CI, 4.61-19.68).
Of all the variables examined, high RPT scores were the best predictor of missing appointments, Woodward said. In addition, when compared with low-risk patients, the high-risk patients were more likely to be older and were less likely to be male. The two groups did not differ based on race.
Woodward said one limitation is that the results are specific to this population and may not be generalizable. She also said the association between RPT score and missed visits needs to be validated. If it is validated, it would allow for stratification of large numbers of patients based on risk.
“This tool could be utilized to target resources aimed to improve appointment attendance to those groups of people considered higher risk,” Woodward said. – by Emily Shafer
For more information:
Woodward B. Abstract 86. Presented at: IDWeek 2014; Oct. 8-12, 2014; Philadelphia.
Disclosure: Woodward reports no relevant financial disclosures.
Perspective
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Although the authors identified black race as a risk factor for missed visits, in our clinic, the Ponce De Leon Center, approximately 89% of patients are black. Thus, this variable does not allow us to effectively identify those who are likely to miss visits. I suspect the same is true at many clinics, as a great majority of the people with HIV in the United States are black. In addition, many of these patients are doing well. We need more granularity to help us identify those who are not likely to do well.