Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
Expert Opinion on Barriers to Hospital Discharge for AIDS Patients
AIDS & Public Policy Journal 5, no. 3 (Summer 1990): 132-36. Mindy Widman, Donald W. Light, and Jerome J. Platt
Hospital care remains the primary mode of treatment for the recurring episodes of illness that characterize AIDS. While such care is necessary and appropriate for the treatment of acute illness, AIDS patients are likely to remain hospitalized beyond the acute stages of illness. Unnecessary hospitalization can thus be a major contributor to escalating health care costs. Avoiding unnecessary hospitalization can reduce patient stress as well as the isolation that is frequently felt. Timely discharge for AIDS patients is believed to be impeded, however, by the presence of social and/or environmental barriers. The lack of suitable out-of-hospital services is most often cited as the principal reason for those failures. Moreover, the relative youth of people with AIDS, along with the stigma attached to the disease itself and to people in the major risk groups, may limit the availability of family and social supports for discharged. Even when appropriate services and social support do exist, a lack of coordination and effective discharge planning can result in the fragmentation of care and missed opportunities for discharge. Additionally, insurance or government funding restrictions on out-of-hospital care may serve to lengthen hospital stays. The source of HIV infection can also affect length of stay, with intravenous drug users (IVDUs) likely to remain hospitalized longer. In addition, drug users are more likely to present with Pneumocystis carinii pneumonia, which requires a greater number of days per admission and is associated with a shorter survival period. Support networks for IVDUs may be weaker and service providers are more likely to see them as "difficult" patients. While these categories of delay are fairly well understood, the specific causes of delay are less well documented.
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Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
