January 8, 2009

Missed Doctors Appointments Bad for Survival

Missed visits to the doctor in the first year of HIV care may double the risk of death, according to a study published in the January 15 issue of Clinical Infectious Diseases.

At least 25 percent of people living with HIV are tested for the virus after their CD4 counts have dropped below 200 or they have already become ill with an AIDS-related problem. This means that the first year of care after testing positive is a critical time, when many need to be followed closely, initiate antiretroviral therapy and learn to adhere to their regimens. Unfortunately, studies show that many who need the greatest level of HIV care during the first year frequently miss appointments. No studies, however, have documented how serious this issue can be.

To examine this, Michael Mugavero, MD, and his colleagues from the University of Alabama in Birmingham (UAB) looked at the medical records of 567 people being treated at the UAB HIV clinic. All of the patients included in the analysis were seen for the first time after testing HIV positive at the UAB clinic between January 2000 and December 2005 and had not previously received HIV care at any other clinic. Mugavero’s team found that 60 percent of the patients missed at least one visit during the first year of care and 40 percent kept all appointments. A missed visit was counted when a person failed to show up for a scheduled appointment and did not call the clinic in advance to cancel or reschedule.

Failing to show up for a scheduled appointment had serious consequences. Mugavero and his colleagues found that the rate of death was 1.3 times higher among people who missed a visit during the first year of care. The authors explained that the missed visits themselves did not cause the increased death rate, but that missed visits are associated with other factors that may influence survival, such as substance use, cultural issues and poverty. They write that further research should be conducted to better understand these factors.

Search: mortality, survival, missed appointments, Michael Mugavero, University of Alabama, Birmingham

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