(P138) Trends in Resource Utilization for Emergency Department Visits Associated with HIV in the United States, 2009 to 2019

Tuesday, July 25, 2023

16:00 – 18:00 CST

Primary Presenter(s)

Khairul A. Siddiqi, PhD

Assistant Research Scientist
University of Florida
Spokane, Washington, United States

Co-author(s)

AA

Asma Alzahrani, Ph.D.

University of South Carolina, United States
DD

Delaney D. Ding, BS

University of Florida, United States
CB

Christopher L Bennett, MD, MSc, MA, FAAEM

Stanford University School of Medicine, United States

Background

Due to advances in antiretroviral therapy, people living with HIV in the United States (US) live longer and may experience increased HIV-associated and age-related comorbidities, which may affect US healthcare delivery, including the emergency departments (EDs). This study analyzes a nationally representative sample of US ED visits to explore differences in patient demographics and resource utilization over time for people living with HIV.

Methods

We analyzed pooled cross-sectional ED visit data from the 2009-10 and 2018-19 National Hospital Ambulatory Medical Care Survey (NHAMCS) for people living with HIV aged 13 years or more. We compared survey-weighted rates of ED visits and resource utilization to describe changes that occurred in the last decade.

Results

The proportions of ED visits associated with HIV for patients aged 55+ increased by 25 percentage points but reduced for all other age categories from 2009-10 to 2018-19. The proportions also increased for males (3.7%, absolute change), individuals of Hispanic ethnicity (3.8%), Medicare recipients (3.9%), in the South (11.4%), and in non-MSA (4.6%) over this time period. Over the period, the ED visits with HIV had an increase in ambulance use (4.0%), any diagnostic/screening services ordered (7.6%), electrocardiogram (7.2%), any imaging (15.0%), any procedures ordered (7.9%), intravenous fluids (5.6%), medications [any medications (1.9%), number of medications prescribed (1.1), number of medications given in ED (0.8)], and seen by a consultant (8.0%). Besides, subsequent visits (4.2%), wait time (14.8 minutes), pain scale (1.0), any blood tests (3.7%), and blood culture (5.3%) were reduced for these visits in 2018-19. Length of ED visit (0.7 hours) and transfer (2.6%) increased; however, the rate of critical care unit admission (0.4%), rate of hospital admission (6.8%), and length of hospital stays (0.7 days), reduced during this time period.

Conclusion

In accordance with demographic changes in the US population with HIV over the last decade, the characteristics and resource utilization of ED visits associated with HIV have changed. These longitudinal changes indicate a shifting need for healthcare services among people living with HIV in EDs. Thus, respective EDs should prioritize customizing the treatment or referral plan based on these trends of ED visits associated with HIV.