       Document 0066
 DOCN  M95A0066
 TI    Access to medical care and health-related quality of life for low-income
       persons with symptomatic human immunodeficiency virus.
 DT    9510
 AU    Cunningham WE; Hays RD; Williams KW; Beck KC; Dixon WJ; Shapiro MF;
       Department of Medicine, School of Medicine, University of; California,
       Los Angeles, USA.
 SO    Med Care. 1995 Jul;33(7):739-54. Unique Identifier : AIDSLINE
       MED/95319247
 AB    Despite growing interest in the accessibility of medical care and
       health-related quality of life for persons infected with human
       immunodeficiency virus, an association between these variables has not
       been documented. The authors conducted a cross-sectional study of access
       to care and its association with health-related quality of life among
       205 persons of low income infected with the human immunodeficiency virus
       with constitutional symptoms and/or diarrhea at one public and one
       Veterans Administration hospital, using a 9-item measure of perceived
       access and a 55-item health-related quality of life instrument. Problems
       with access were widespread: 55% traveled for longer than 30 minutes to
       their usual source of care (compared with 9% to 12% of general
       populations in national surveys), 49% had problems meeting costs of
       care, and 48% had problems with clinic hours (compared with 23% in
       national surveys). In multivariate analyses, uninsured patients reported
       worse access than patients with Medicaid or Veterans Administration
       insurance, particularly for meeting the cost of care (P < 0.01).
       Adjusted health-related quality of life scores in this sample were far
       lower (by about 1 SD) than those of subjects in a large national
       acquired immune deficiency syndrome clinical trial. For 8 of 11
       health-related quality of life subscales, worse perceived access was
       significantly (P < 0.05) associated with poorer health-related quality
       of life, even after controlling for T-4 lymphocyte count, symptoms and
       other factors. Access and health-related quality of life measures
       similar to those used in this study may prove useful in future
       evaluations of medical care systems serving poor, clinically ill
       populations infected with human immunodeficiency virus.
 DE    *Acquired Immunodeficiency Syndrome/ECONOMICS/THERAPY  Adult  Cohort
       Studies  Cross-Sectional Studies  Female  *Health Services
       Accessibility/ECONOMICS  *Health Status  Human  Insurance, Health  Male
       Medically Uninsured  *Poverty  *Quality of Life  Support, Non-U.S. Gov't
       Support, U.S. Gov't, P.H.S.  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

