ABSTRACT
We wished to determine whether antiretroviral therapy with zidovudine first received when a person is diagnosed with AIDS was associated with diminished or increased direct health resource utilization. As a measure of health resource utilization, we examined all Medicaid-administered health care charges to adult Maryland residents diagnosed with AIDS from 1987 to 1989 who were part of the Human Immunodeficiency Virus Information System. We specifically compared those persons who first received zidovudine therapy either prior to or within 60 days of diagnosis of AIDS (n = 101) with those who never received zidovudine therapy (n = 279). Median survival time after diagnosis of AIDS in those who received zidovudine was 605 days and in those who did not receive zidovudine 235 days. After diagnosis of AIDS, median per-person lifetime direct health care charges to Medicaid were $66,200 in those who received zidovudine and $31,300 in those who did not receive zidovudine. The median incremental charge per year of life gained in zidovudine users was $34,600 compared with nonusers. Adjusting by proportional hazards regression for age, gender, race/ethnicity, HIV transmission risk group, AIDS-defining diagnosis, and length of follow-up, lifetime Medicaid charges were higher in zidovudine receivers. Compared with patients who did not receive zidovudine, patients who first received zidovudine at the time AIDS was diagnosed incurred higher cumulative lifetime charges, associated principally with longer survival time. The rate of resource utilization was not decreased by zidovudine use.
Subject(s)
Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/economics , Health Resources/statistics & numerical data , Zidovudine/therapeutic use , Acquired Immunodeficiency Syndrome/mortality , Adult , Cost-Benefit Analysis , Female , Follow-Up Studies , Health Care Costs , Health Resources/economics , Humans , Information Systems , Longitudinal Studies , Male , Maryland , Medicaid/economics , Middle Aged , Probability , Proportional Hazards Models , Survival Analysis , Time Factors , United StatesABSTRACT
A cohort of 544 human immunodeficiency virus-1 (HIV-1) seropositive intravenous drug users (IVDUs) was recruited in 1988 and early 1989; data on laboratory markers, clinical symptoms, intravenous drug use, and demographics were collected. Forty-one IVDUs developed AIDS within 2 years of enrollment. Data were analyzed using methods of survival analysis. None of the individuals reported use of antiviral agents or Pneumocystis carinii prophylaxis at baseline. A very strong (p less than 0.001) dose-response relationship was identified between CD4 cell count at baseline and the subsequent development of AIDS. In multivariate analysis, both the presence of more than one clinical HIV-1-related symptom and serum neopterin greater than 12 nmol/L showed significant associations with the relative hazard (95% confidence interval) of AIDS after controlling for CD4 of 2.9 (1.6, 5.6) and 2.0 (1.0, 3.7), respectively. In these IVDUs, serum beta 2-microglobulin did not add predictive power for progression to AIDS. The effect of clinical symptoms was stronger for high CD4 cell counts, indicating the need to monitor HIV seropositive IVDUs with both laboratory studies and clinical evaluation.
Subject(s)
Acquired Immunodeficiency Syndrome/etiology , Substance Abuse, Intravenous , Acquired Immunodeficiency Syndrome/blood , Acquired Immunodeficiency Syndrome/physiopathology , Adult , Cohort Studies , Demography , Female , Humans , Male , Prognosis , Prospective Studies , Risk FactorsABSTRACT
A systematic manual search for articles related to consultation-liaison psychiatry was compared to a computerized search of the same journals during the same period that was done with the Medical Literature Analysis and Retrieval System (MEDLARS). More articles were located with the manual method (94%) than with MEDLARS (65%).
Subject(s)
MEDLARS/standards , Periodicals as Topic , Psychiatry , Referral and Consultation , Abstracting and Indexing/standards , Evaluation Studies as Topic , Humans , United StatesABSTRACT
Methodology is receiving overdue attention in psychiatric research. This article focuses on biases encountered in studies in consultation-liaison psychiatry. A classification of biases derived from epidemiology is presented, and the expected impact of each bias is discussed. Methods to minimize bias in the design and implementation of consultation-liaison research are suggested.
Subject(s)
Health Services Research/trends , Neurocognitive Disorders/therapy , Psychophysiologic Disorders/therapy , Psychotherapy/trends , Sick Role , Bias , Humans , Referral and Consultation/trendsABSTRACT
Two hundred forty-one nursing home patients from the National Nursing Home Survey Pretest were assessed using the Ischemic Score of Hachinski. Medical chart diagnoses were used to classify those with and without dementia. The Mini-Mental State Examination was used to assess the accuracy of the medical-chart diagnoses of dementia. The Ischemic Score failed to differentiate multi-infarct dementia from other types of dementias. Instead, the difference between the two dementia groups was in the direction opposite that predicted by Hachinski.
