Clinic Hopping Isn't Good for Your Health

New numbers back up what doctors have long told us.

BY Trudy Ring

January 08 2014 5:00 AM ET

There’s new evidence that having a consistent relationship with only one HIV care provider is good for your health, according to a study out of Philadelphia. The study, which followed 13,000 patients from 2008 to 2010, found that those who received care at multiple clinics had worse outcomes—they were less likely to receive antiretroviral drugs and to achieve viral suppression. Multiple providers treated about 1,000 of the subjects; only 69 percent of them received antiretroviral meds and 68 percent achieved a suppressed viral load, compared with 83 percent and 89 percent, respectively, for those who kept going to the same clinic.
 
Those who visited multiple clinics tended to be younger and were more likely to be black, female, uninsured or on public insurance, and in their first year of care than those who only went to one clinic, researchers reported.
 
“It’s about retention in care but also continuity, two related but distinct processes,” says senior author Kathleen A. Brady, MD, an infectious disease physician at Pennsylvania Hospital and medical director–medical epidemiologist for the Philadelphia Department of Public Health’s AIDS Activities Coordinating Office.
 
The study, published in the journal AIDS and Behavior, used data from the health department on patients at the 26 Philadelphia HIV clinics that receive federal funding through the Ryan White CARE Act. It was conducted by Penn Medicine, which includes the University of Pennsylvania’s Perelman School of Medicine, several hospitals, and other institutions.
 
There’s no definitive word in this study on why some HIV-positive folks see multiple care providers, though researchers suggest that poverty, stigma, the presence of other health problems, and limited access play a role.
 
“I’m hopeful that by providing this data to HIV clinicians,” says Brady, “we can get a better understanding of why patients see multiple providers and make improvements to the system.”

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