Missing the mark: Ongoing missed opportunities for HIV diagnosis at an urban medical center despite universal screening recommendations

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2 Citations (Scopus)

Abstract

Background. Despite established recommendations from the Centers for Disease Control (CDC) to scale up testing efforts in the USA, this study shows full scale implementation of these recommendations may still be lacking. We hypothesize that patients experience ongoing missed opportunities for earlier diagnosis of HIV, despite frequent encounters to Montefiore Medical Center (MMC), an integrated hospital system in the Bronx, NY. Methods. Retrospective chart review via electronic medical records of patients newly diagnosed with HIV in 2012 and 2013 at varied MMC clinical sites. Missed opportunities were defined as > 1 prior health care encounter at MMC within three calendar years of diagnosis, in which HIV testing was not offered for those who had a prior negative test or no prior test. Results. There were 218 patients newly diagnosed with HIV at MMC during the study period; 31% presented with a CD4 < 200 cells/mm3; 22% were asymptomatic at diagnosis. Patients (56%) without a prior HIV test had an average 4.72 clinical encounters at MMC within the 3 years prior to their HIV diagnosis. Over 95% of visits prior to diagnosis occurred in emergency departments (EDs) or primary care outpatient department (OPDs) and accounted for the vast majority of missed opportunities. Conclusions. HIV infected patients continue to present late to care, with low CD4 and commonly utilize OPDs and EDs, where missed opportunities for earlier diagnosis are common. Practices that address augmentation of current HIV testing strategies are needed, especially in outpatient and first-contact acute care settings.

Original languageEnglish (US)
Pages (from-to)644-648
Number of pages5
JournalFamily Practice
Volume33
Issue number6
StatePublished - 2016

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HIV
Outpatients
Hospital Emergency Service
Early Diagnosis
Electronic Health Records
Emergency Medical Services
Centers for Disease Control and Prevention (U.S.)
Primary Health Care
Delivery of Health Care

Keywords

  • Health disparities
  • HIV testing
  • HIV/AIDS
  • Missed opportunities
  • Primary care
  • Underserved populations

ASJC Scopus subject areas

  • Family Practice

Cite this

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title = "Missing the mark: Ongoing missed opportunities for HIV diagnosis at an urban medical center despite universal screening recommendations",
abstract = "Background. Despite established recommendations from the Centers for Disease Control (CDC) to scale up testing efforts in the USA, this study shows full scale implementation of these recommendations may still be lacking. We hypothesize that patients experience ongoing missed opportunities for earlier diagnosis of HIV, despite frequent encounters to Montefiore Medical Center (MMC), an integrated hospital system in the Bronx, NY. Methods. Retrospective chart review via electronic medical records of patients newly diagnosed with HIV in 2012 and 2013 at varied MMC clinical sites. Missed opportunities were defined as > 1 prior health care encounter at MMC within three calendar years of diagnosis, in which HIV testing was not offered for those who had a prior negative test or no prior test. Results. There were 218 patients newly diagnosed with HIV at MMC during the study period; 31{\%} presented with a CD4 < 200 cells/mm3; 22{\%} were asymptomatic at diagnosis. Patients (56{\%}) without a prior HIV test had an average 4.72 clinical encounters at MMC within the 3 years prior to their HIV diagnosis. Over 95{\%} of visits prior to diagnosis occurred in emergency departments (EDs) or primary care outpatient department (OPDs) and accounted for the vast majority of missed opportunities. Conclusions. HIV infected patients continue to present late to care, with low CD4 and commonly utilize OPDs and EDs, where missed opportunities for earlier diagnosis are common. Practices that address augmentation of current HIV testing strategies are needed, especially in outpatient and first-contact acute care settings.",
keywords = "Health disparities, HIV testing, HIV/AIDS, Missed opportunities, Primary care, Underserved populations",
author = "Liggett, {Alisha L.} and Futterman, {Donna C.} and Umanski, {Galina I.} and Selwyn, {Peter A.}",
year = "2016",
language = "English (US)",
volume = "33",
pages = "644--648",
journal = "Family Practice",
issn = "0263-2136",
publisher = "Oxford University Press",
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T1 - Missing the mark

T2 - Ongoing missed opportunities for HIV diagnosis at an urban medical center despite universal screening recommendations

AU - Liggett, Alisha L.

AU - Futterman, Donna C.

AU - Umanski, Galina I.

AU - Selwyn, Peter A.

PY - 2016

Y1 - 2016

N2 - Background. Despite established recommendations from the Centers for Disease Control (CDC) to scale up testing efforts in the USA, this study shows full scale implementation of these recommendations may still be lacking. We hypothesize that patients experience ongoing missed opportunities for earlier diagnosis of HIV, despite frequent encounters to Montefiore Medical Center (MMC), an integrated hospital system in the Bronx, NY. Methods. Retrospective chart review via electronic medical records of patients newly diagnosed with HIV in 2012 and 2013 at varied MMC clinical sites. Missed opportunities were defined as > 1 prior health care encounter at MMC within three calendar years of diagnosis, in which HIV testing was not offered for those who had a prior negative test or no prior test. Results. There were 218 patients newly diagnosed with HIV at MMC during the study period; 31% presented with a CD4 < 200 cells/mm3; 22% were asymptomatic at diagnosis. Patients (56%) without a prior HIV test had an average 4.72 clinical encounters at MMC within the 3 years prior to their HIV diagnosis. Over 95% of visits prior to diagnosis occurred in emergency departments (EDs) or primary care outpatient department (OPDs) and accounted for the vast majority of missed opportunities. Conclusions. HIV infected patients continue to present late to care, with low CD4 and commonly utilize OPDs and EDs, where missed opportunities for earlier diagnosis are common. Practices that address augmentation of current HIV testing strategies are needed, especially in outpatient and first-contact acute care settings.

AB - Background. Despite established recommendations from the Centers for Disease Control (CDC) to scale up testing efforts in the USA, this study shows full scale implementation of these recommendations may still be lacking. We hypothesize that patients experience ongoing missed opportunities for earlier diagnosis of HIV, despite frequent encounters to Montefiore Medical Center (MMC), an integrated hospital system in the Bronx, NY. Methods. Retrospective chart review via electronic medical records of patients newly diagnosed with HIV in 2012 and 2013 at varied MMC clinical sites. Missed opportunities were defined as > 1 prior health care encounter at MMC within three calendar years of diagnosis, in which HIV testing was not offered for those who had a prior negative test or no prior test. Results. There were 218 patients newly diagnosed with HIV at MMC during the study period; 31% presented with a CD4 < 200 cells/mm3; 22% were asymptomatic at diagnosis. Patients (56%) without a prior HIV test had an average 4.72 clinical encounters at MMC within the 3 years prior to their HIV diagnosis. Over 95% of visits prior to diagnosis occurred in emergency departments (EDs) or primary care outpatient department (OPDs) and accounted for the vast majority of missed opportunities. Conclusions. HIV infected patients continue to present late to care, with low CD4 and commonly utilize OPDs and EDs, where missed opportunities for earlier diagnosis are common. Practices that address augmentation of current HIV testing strategies are needed, especially in outpatient and first-contact acute care settings.

KW - Health disparities

KW - HIV testing

KW - HIV/AIDS

KW - Missed opportunities

KW - Primary care

KW - Underserved populations

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