Study: HIV Patients with Case Managers Have Fewer Unmet Needs

HIV-infected adults with case managers who help coordinate their health care had fewer unmet needs and higher use of HIV medications, according to a study in today's issue of Annals of Internal Medicine (October 16, 2001; 135 (8): 557-565). The study reported on 2,437 HIV-infected adults who visited inpatient and outpatient medical facilities in 52 urban and rural areas in 1996 and 1997. After looking at the patients at the start of the study and again six months later, researchers found that nearly 66 percent of those without case managers had needs that were not met -- nearly 10 percentage points higher than the level of unmet needs for patients who had case managers.

Patients with case managers were more likely to get income assistance, health insurance, emotional counseling, substance abuse treatment and other care. They also were more likely to get medicines like drug combination therapy and protease inhibitors, a factor that the study's lead author Dr. Mitchell H. Katz said he found "startling." The study noted that an increasing number of people with HIV are living in poverty and need both support services and medical care, making the role of case managers particularly important for doctors and patients. Still, the study noted that just 56 percent of HIV patients had case managers and that more funding is needed to get assistance -- and medications -- to where they're needed.

"Unless funds increase, we'll have to put new clients on a waiting list or discharge existing clients," said Kevin R. Conare, executive director of Action AIDS, Philadelphia's largest provider of HIV case management services. In a related editorial, also in today's Annals, Conare and Dr. William C. Holmes of the University of Pennsylvania School of Medicine said that case management services for HIV-infected people are at risk if federal funding is not increased. Most money now comes from the federal Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. The Bush administration's fiscal 2002 budget froze the program's funding at $1.8 billion -- the same amount as 2001. Holmes said the program needs $300 million more.

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