A project supported by: WRMA’s Ryan White Data Support and Technical Assistance (DSTA) team
HRSA HAB chooses WRMA
to study how Ryan White HIV/AIDs clinics provide primary care medical services
Client:
U.S. Department of Health and Human Services (HHS)
Health Resources and Services Administration (HRSA)
HIV/AIDS Bureau (HAB)
Service Areas
Areas of Expertise
Summary
The Ryan White HIV/AIDS Program (RWHAP) is the third-largest funder of HIV care in the U.S. after Medicare and Medicaid and the single-largest federal program designed specifically to provide care to people with HIV. While effective antiretroviral treatment allows people with HIV to live longer lives, they often also develop other chronic disease common among aging patients, including diabetes, heart disease and hypertension. Primary care services are now an essential component to HIV/AIDS care, but at the time this research was conducted, little research had been done to see how Ryan White clinics were providing these services. The WRMA Team conducted a two-phase study to identify what services were being provided, what services were referred to other providers and why, how services were managed, and how patient information was shared among providers.
Details
For Phase 1, the WRMA Team drew a sample of adult and pediatric providers from RWHAP-funded outpatient/ambulatory, medical clinics to study their care models and services. WRMA administered online surveys with clinic directors to obtain an overview of how primary care services were delivered and coordinated.
For Phase 2, WRMA conducted an in-depth study of a subset of providers, which included a clinician survey, medical chart review and medical director interview. Providers were stratified by provider type and size. The WRMA Team used guidelines published by the HIV Medicine Association of the Infectious Disease Society of America (HIVMA/IDSA) and the New York State Department of Health AIDS Institute to help assess the collected data. WRMA designed the data collection instruments, finalized the project design and prepared the sample, and facilitated the OMB process of obtaining approval to conduct in-person piloting of the data collection. Survey responses were analyzed using quantitative and qualitative methods.
Results of the study found that the majority of RWHAP-funded providers are rendering primary and preventive care services in various ways that incorporate their healthcare system capacity, patient health insurance, and patient preference and circumstances. The main findings include:
- The vast majority of RWHAP-funded providers in the study are rendering at least some primary and preventive care.
- Breast cancer, colorectal cancer and osteoporosis screenings are the services most commonly referred to outside providers.
- Providers reported that many services are done at least annually.
- A handful of providers primarily focus on rendering HIV care and referring primary care services due to organizational constraints.
- Patients receive primary care and preventive services elsewhere due to healthcare coverage options and patient preference.
- Patient information sharing is a major barrier to coordinating their care when multiple providers are involved.
- People living with the disease depend on an HIV specialist for their comprehensive care.
- Case managers play a critical role in tracking utilization of primary and preventive care, encouraging non-compliant patients to obtain care, and connecting patients to wraparound services.
