HRIPD visits were more likely to result in admission [adjusted
odds ratio (OR) 7.67; 95% confidence interval (CI) 5.14–11.44]. The proportion of HRIPD visits that required emergent/urgent care or were seen by attending physicians, and the number of diagnostic tests ordered, significantly increased over time (P<0.05), while the check details wait time (P=0.003) significantly decreased between the second and third study periods (P<0.05). Although HRIPD visits were infrequent relative to all ED visits, HRIPD visits utilized significantly more resources than non-HRIPD visits and the utilization also increased over time. In the USA, the incidence of HIV infection increased during the mid-1990s, decreased after 1999, and has been stable in recent years, with an estimated 56 000 newly infected individuals each year [1]. Mortality decreased steadily after the initiation of highly active antiretroviral therapy (HAART) [2,3], and this decrease was accompanied by an increase in the prevalence of people living with HIV infection [4], which rose from approximately 630 000–897 000 in 1993 [5], to more than 1 million in
2006 [6]. HIV-infected adults visit emergency departments (EDs) three-to-four times more frequently than the general population [7–9]. The annual cost of ED visits by these individuals has been estimated at $100 million [7]. HIV-infected patients visiting the ED present with a wide spectrum of symptoms, with up to two-thirds PF-562271 likely to have an HIV/AIDS-related illness [10,11], and approximately one-quarter experiencing their first known HIV-related condition [10]. As the AIDS epidemic progresses and more individuals are living with HIV/AIDS,
the number of HIV/AIDS-related ED encounters will continue to grow [12]. In the literature on ED visits by known HIV-positive individuals, the chief complaints not related to HIV/AIDS include injury, trauma and ‘other’. ED utilization in these visits does not really reflect the direct impact of HIV/AIDS, and thus this is likely to be overestimated. However, there have been no studies to date that directly explore the characteristics of ED utilization for patients with HIV/AIDS-related illness as the primary ED diagnosis (HRIPD). Knowledge of the characteristics and resource utilization patterns of ED visits with HRIPD (hereafter Epothilone B (EPO906, Patupilone) ‘HRIPD visits’) would be helpful in optimizing resource allocation for people living with HIV/AIDS, and could potentially be useful in helping to reduce ED utilization by this subpopulation, which contributes to ED crowding and overuse of ED resources. ED or hospital resource utilization might be offset by ambulatory care for patients newly diagnosed with AIDS [13]. While Hellinger found a dramatic reduction in the utilization of hospital services by, and the cost of the provision of these services to, HIV-infected persons from 2000 to 2004 [14], the trend of ED resource utilization before and after the initiation of HAART remains unknown.