Transcript latino gay

Understanding Barriers and Facilitators Experienced by HIV Care Providers When Engaging and Retaining Patients in Care:
Results from a Qualitative Study
Jamie Hart, PhD, MPH1; Cynthia Klein, PhD2; Alejandra Mijares, MPH2; Theresa Spitzer, PhDc1; Clarke Erickson, MHA1; James W. Carey, PhD, MPH3; Monique Carry, PhD3; Deborah Gelaude, MPH3; Nicole Pitts, BS4; and Damian Denson, PhD, MPH3
1 Atlas
Research, 2 Abt Associates, 3 U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, 4 ICF International
RESULTS: FACILITATORS TO ENGAGEMENT AND RETENTION
BACKGROUND/METHODOLOGY
Strategy
Problem: It is estimated that 60% of
PLWH in the US are not receiving
consistent HIV care due to delayed
diagnosis, inadequate linkage to care,
and barriers to retention to HIV care.
Example quotes reflecting common/prominent themes within the data
Availability of a
Broad Range of
Providers In a
Single Location
Purpose: To collect qualitative data
from 30 HIV care providers in three
major metropolitan areas regarding
perceived barriers and facilitators to
engaging patients in HIV care.
Offering
Supportive
Services
Rationale: While small in scope, this
study:
 Has important implications in the
ongoing efforts to improve the HIV
continuum of care.
 Supports the role and importance
of HIV care providers in effectively
reducing the gap in continuous and
consistent HIV care.
Analysis:
 Interviews were recorded, transcribed, and coded by patterns and themes.
 Analysis was conducted using NVivo® 10 qualitative data analysis software.
 Descriptive statistics of demographic data were performed using SPSS® statistical software.
Flexibility of
Clinic
Procedures and
Providers to
Meet Unique
Needs of
Patients
25-34 years
35- 44 years
45-54 years
More than 55 years
Hispanic or Latino/a
Non-Hispanic or Latino/a
Asian
Black/African American
White
Female
Male
Homosexual, gay/lesbian
Heterosexual or straight
Bisexual
Atlanta, GA
2 (20%)
3 (30%)
3 (30%)
2 (20%)
10 (100%)
3 (30%)
7 (70%)
5 (50%)
5 (50%)
2 (20%)
8 (80%)
-
Baltimore, MD
4 (40%)
2 (20%)
1 (10%)
3 (30%)
10 (100%)
1 (10%)
2 (20%)
7 (70%)
8 (80%)
2 (20%)
2 (22.2%)
5 (55.6%)
2 (22.2%)
Washington, DC
3 (33%)
1 (11.1%)
4 (44.4%)
1 (11.1%)
6 (60%)
4 (40%)
9 (90%)
6 (60%)
4 (40%)
3 (33.3%)
5 (55.6%)
1 (11.1%)
Total
9 (31%)
6 (20.7%)
8 (27.6%)
6 (20.7%)
6 (20%)
24 (80%)
1 (3.4%)
5 (17.2%)
23 (79.3%)
19 (63.3%)
11 (36.7%)
7 (25%)
18 (64.3%)
3 (10.7%)
“This is the only place they want to go when they leave their house.
We have their medications delivered here and the pharmacist helps
distribute them to them and makes sure it’s organized….I think that is
why people come [here] because they can walk in and they know all of
us. A lot of people call us their family.” – Nurse Practitioner,
Washington
RESULTS: BARRIERS TO ENGAGEMENT AND RETENTION
Strategy
PROVIDER DEMOGRAPHICS
“The amount of resources we have in terms of nursing support, having
social workers onsite, having dieticians onsite, having a specific nurse
educator onsite, having a peer educator onsite. Having all of that
here keeps the patient from having to try and corral all of these
resources from multiple organizations. We can actually have access
to a lot of those things here and you have an advocate for you that’s
in your doctor’s office.” – Physician, Atlanta
“[Patients] don’t have to qualify for our services even if they’ve lost
their insurance. They can still come see us [the social workers] and we
don’t just kick them to the curb. It’s “how can we help you stay
engaged in care? How can we get you insurance again?” There are
some times with some people where it’s just not financially realistic
for them to stay in a private practice…and we’re very instrumental in
helping them connect to another practice.” –Case Manager, Atlanta
Logistical
Financial, and
Capacity-based
Barriers to
Connecting
Patients to
Needed Services
Issues Related to
Insurance
Coverage
Continuing
Stigma and
Misconception
of HIV as a
Disease
Example quotes reflecting common/prominent themes within the data
“Frankly, with the system as it is now I feel overwhelmed trying to
finish four patients in a half day. By the time you address substance
abuse, mental health, safe sex the list goes on and not to mention
their asthma or any other health issue. We end up doing a lot of
primary care, which I love as a primary care physician, but it’s
exhausting.” – Physician, Atlanta
“There has always been the pushback from insurers about what is
covered, whether it is laboratory tests or even medications. [You
decide] to start this patient on meds, this patient wants to start, but
insurers put up this road block.” – Physician, Atlanta
“Somebody doesn’t want to take the medication because somebody
lives in their house and they don’t want it to be found so they refuse
medication. They refuse treatment. Somebody can’t get support
because they can’t tell their family because of the stigma.” – Nurse
Practitioner, Washington
PRACTICAL IMPLICATIONS OF RESPONDENT STRATEGIES
TO FACILITATE ENGAGEMENT AND RETENTION IN CARE
The following implications were derived from the analysis process and
identification of common/prominent themes within the data.
Treat the “Whole Patient”
 Ensure that HIV care providers and facilities include ‘whole patient’
needs.
 Build capacity of healthcare facilities to be a “one stop shop” for the
full spectrum of HIV care (e.g., co-located services, plus active
referral and linkage to external health and social services).
 Increase the involvement of pharmacists.
Enhance the Flexibility of Providers and Clinic Procedures
 Conduct additional research to better understand the impact of
insurance- and medication-related policies on engagement in HIV
care.
 Train primary care providers to manage patients who are virally
suppressed to supplement the work of HIV specialist providers.
 Strengthen monitoring and evaluation of care engagement within
facilities (including identification and follow-up with patients who fall
out of care).
Improve Patient/Provider Relationships and Communication
 Obtain and include patient perspectives on what they need to
successfully be engaged in HIV care (e.g., culturally competent
communication and creation of a sense of shared responsibility and
decision making).
 Specific needs may:
o Vary between individual patients.
o Vary between patient subgroups.
o Evolve over time for a patient, patient subgroup, facility, or
community.
o Require diversity among and training for staff at all levels.
Address Stigma and Misconception of HIV as a Disease
 Ensure that care facilities feel welcoming and non-stigmatizing to
patients.
 Help patients develop skills for handling stigma outside of the
facility.
Identify and Share Lessons Learned
 Identify effective and useful promising practices.
 Facilitate opportunities to share successful care engagement
strategies between different providers and facilities.