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Impact of Patient–Provider Attachment on Hospital Readmissions Among People Living With HIV

A Population-Based Study

Parent, Stephanie, MPH*; Barrios, Rolando, MD*,†; Nosyk, Bohdan, PhD*,‡; Ye, Monica, BSc*; Bacani, Nicanor, BSc*; Panagiotoglou, Dimitra, PhD*; Montaner, Julio, MD*,§; Ti, Lianping, PhD*,§

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 15, 2018 - Volume 79 - Issue 5 - p 551–558
doi: 10.1097/QAI.0000000000001857
Epidemiology

Background: Hospital readmission 30 days after discharge is associated with adverse health outcomes, and people living with HIV (PLWH) experience elevated rates of hospital readmission. Although continuity of care with a health care provider is associated with lower rates of 30-day readmission among the general population, little is known about this relationship among PLWH. The objective of this study is to examine whether engaging with the same provider, defined as patient–provider attachment, is associated with 30-day readmission for this population.

Setting: Data were derived from the Seek and Treat for Optimal Prevention of HIV in British Columbia cohort.

Methods: Using generalized estimating equation with a logit link function, we examined the association between patient–provider attachment and 30-day hospital readmission. We determined whether readmission was due to all cause or to a similar cause as the index admission.

Results: Seven thousand thirteen PLWH were hospitalized during the study period. Nine hundred twenty-one (13.1%) were readmitted to hospital for all cause and 564 (8.0%) for the similar cause as the index admission. Patient–provider attachment was negatively associated with 30-day readmission for all causes (adjusted odds ratio = 0.85, confidence interval = 0.83 to 0.86). A second multivariable model indicated that patient–provider attachment was also negatively associated with 30-day readmission for a similar cause (adjusted odds ratio = 0.86, confidence interval = 0.84 to 0.88).

Conclusions: Our results indicate that a higher proportion of patient–provider attachment was negatively associated with 30-day hospital readmission among PLWH. Our study findings support the adoption of interventions that seek to build patient–provider relationships to optimize outcomes for PLWH and enhance health care sustainability.

*British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada;

Vancouver Coastal Health, Vancouver, British Columbia, Canada;

Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; and

§Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada.

Correspondence to: Lianping Ti, PhD, British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada (e-mail: mintti@cfenet.ubc.ca).

Supported by the British Columbia Ministry of Health (BCMoH), which funded Seek and Treat for Optimal Prevention of HIV & AIDS pilot project, and an Avant-Garde Award (number 1DP1DA026182) and grant 1R01DA036307-01 from the National Institute of Drug Abuse at the US National Institutes of Health. The funder had no direct role in the conduct of the analysis or the decision to submit the manuscript for publication. L.T. and B.N. are supported by a Michael Smith Foundation for Health Research Scholar Award. J.M.'s Treatment as Prevention (TasP) research, paid to institution, has received support from the Public Health Agency of Canada, BC-Ministry of Health, and US NIH (NIDA R01DA036307 and CTN 248). Institutional grants have been provided by J&J, Merck, and a Knowledge Translation Award from CIHR.

J.M. has served as an advisor to the federal and BC governments, UNAIDS, and WHO in the past year. All inferences, opinions, and conclusions drawn in this publication are those of the author(s) and do not necessarily reflect the opinions or policies of the data steward. The remaining authors have no conflicts of interest to disclose.

Received April 25, 2018

Accepted August 10, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.