Engagement in Care: What Works

Engagement in Care: What Do We Know? ,[object Object],[object Object],[object Object]

Continuum Engagement in Care Not in Care Fully Engaged Non-engager Sporadic User Fully Engaged Health Resources Service Administration (HRSA) Unaware of HIV Status (not tested or never received results) Know HIV Status (not referred to care; didn ’ t keep referral) May Be Receiving Other Medical Care But Not HIV Care Entered HIV Primary Medical Care But Dropped Out (lost to follow-up) In and Out of HIV Care or Infrequent User Fully Engaged in HIV Primary Medical Care

Why Is Retention Important for People Living with HIV? Population Appointments Health Outcome 123 patients, primary care clinic, (Rastegar, 2003) Baltimore Not specified which appts. included Associated with VL> 500 copies/ml 273 patients, large urban clinic in Baltimore (Lucas, 1999) Nursing, psychiatry, dermatology, neurology and gastroenterology Associated with failure to suppress VL 195 patients, JHU outpatients center (Sethi, 2003) “ Scheduled clinic visit” Associated with viral rebound and clinically significant resistance 366 patients, HIV clinic in Cleveland (Valdez, 1999) “ Clinic visit” Missing <2 appts. associated lower VL (<400 copies/mL)

Missed Visits and Mortality Mugavero, et. al. 2009 UAB. CID 48:248-56. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Measurement ,[object Object],[object Object],[object Object],[object Object]

No-Show Rates: aka “DNKA” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Retention Rates ,[object Object],[object Object]

Retention Rates ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Who misses appointments? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Why Do HIV Patients Not Come to Clinic? ,[object Object],[object Object],[object Object]

Evidence Base for Strategies to Connect Patients to Care

ARTAS Study Gardner LI, Metsch LR, Anderson-Mahoney P, et al. Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. AIDS 2005: 19:423-31. ,[object Object],[object Object],[object Object]

Outreach Initiative: HRSA SPNS Multi-site Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Outreach Initiative: Major Findings (Cabral, et. al. 2007; AIDS Patient Care & STDs) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Outreach Initiative: Major Findings 2 Factors Associated with Engagement Rumptz, et. al. 2007 AIDS Patient Care & STDs. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],** financial assistance, housing, benefits assistance, transportation, mental health care, food, and substance abuse treatment * Difficulty paying for care, getting appointment at a convenient time, making an appointment because of no telephone, getting someone to answer calls to make an appointment, locating care, and finding providers who speak the same language

Outreach Initiative Major Findings 3: System Navigators Bradford, et. al. 2007 AIDS Patient Care & STDs. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Outreach Initiative: Qualitative Findings Rajabiun 2007: AIDS Patient Care & STDs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Clinic Operation and Information System Strategies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Increasing Patient and Staff Awareness ,[object Object],[object Object],[object Object],[object Object]

Practical Strategies ,[object Object],[object Object],[object Object]

Practical Strategies (2) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Contacts ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Engagement in Care: What Works

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