The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #68923

Grant Colfax, MD¹, Herminia Palacio, MD, MPH², Annemarie Heineman, JD³, David Guzman, MSPH⁴, Misty Schultz³, Andrew R Moss, PhD⁵, and David Bangsberg, MD⁴. (1) AIDS Office, San Francisco Department of Public Health, 25 Van Ness, Suite 710, San Francisco, CA 94102, 415-554-9173, grant.colfax@sfdph.org, (2) Harris County Public Health & Environmental Services, 2223 West Loop South, Suite 500, Houston, TX 77027, (3) Epidemiology and Prevention Interventions Center, University of California, San Francisco, 482 Ellis Street, San Francisco, CA 94102, (4) Department of Medicine, University of California, San Francisco, 1001 Potrero Avenue, Campus Box 1372, San Francisco General Hospital - Building 100, San Francisco, CA 94110, (5) University of California, San Francisco, Epidemiology & Biostatistics, San Francisco, CA 94105

Background: The impact of case managers (CMs) on health is largely unexplored. We examined the association of receiving CM services on the health and medical service use of the HIV-infected, marginally housed urban poor. Methods: Participants were selected from shelters, meal programs, and SRO hotels, using probability-based sampling. 86% of eligibles enrolled. Interviews and CD4 counts were performed quarterly. CMs were contacted and verified meeting with the clients. Analyses included multivariate linear and Poisson regressions. Results: Of 280 participants enrolled, 217 (78%) completed the study within one year. Median age was 42, 57% were persons of color, 80% reported substance use, 25% reported at least one homeless night in the prior 3 months. At baseline, 59% of participants met with a CM; 91% of CMs discussed medical care with their client; 62% spoke with a medical provider on the client’s behalf. At one year follow-up, median CD4 count of participants with a CM at baseline was 71 cells/ml greater than persons with no CM (p= .001), adjusting for baseline CD4 count and retroviral use. Compared with no CM at baseline and adjusting for CD4 count, persons with a CM also reported more visits to their primary care provider (13.7 vs. 11, p <.001), emergency room visits (1.4 vs. .72, p < .001), and hospital admissions (.95 vs. .42, p <.001). Conclusions: Receiving CM services is associated with improved health status and greater use of medical services, suggesting that CMs are facilitating increased but appropriate medical care in this vulnerable population.

Learning Objectives:

• Recognize the impact of case management services on health for HIV-infected, urban poor. Evaluate changes in health status and health service use between clients with case managers versus those without. Articulate specific health benefits for those with case managers.

Keywords: Case Management, Homeless Health Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.