Ambulatory AIDS care for those with special needs–Children, women, and drug users

The Nature of Multidisciplinary HIV Care in the Ambulatory Setting: A Synthesis of the Literature

“…When studying the care of PWHA, it should be noted that the unpredictability of the disease trajectory (Gordon, 1998;Henry & Costantino, 1996;Volberding, 1985;Young, Bishburg, Boland, Conviser, & Jackson, 1988) makes the standardization of care difficult. The nature of HIV/AIDS necessitates a multidisciplinary approach to care, as evidenced by the variability in physical, psychosocial, emotional, and spiritual needs experienced by PWHA (Campbell & Rader, 1990;Gordon, 1998;Hayes & Carroll, 1995;Pascarelli & Holtzworth, 1987;Satterwhite, Settle, Cushnie, & Kaplowitz, 1991;Sherer et al, 2002;Sowell & Grier, 1995).…”

“…Nevertheless, most clinics tend to employ full-time, part-time, and contract staff or a combination of the three. Generally, most clinics employ nurses, physicians, and social workers; other staff members may consist of psychiatrists, psychologists, alcohol/drug abuse counselors, dentists, chaplains, dietitians, oncologists, clinical pharmacists, administrative personnel, speech therapists, and alternative care providers (Cantwell-McNelis & James, 2002;Cicatiello & Perdue, 1994;Dykeman et al, 1996;Harrow et al, 1994;Hayes & Carroll, 1995;Howes, 1984;Jacobs, Damson, & Rogers, 1996;"North Carolina Clinic," 2001;Nuffer, 1991;Pfeffer & Schnack, 1995;Rosner, 1985;Satterwhite et al, 1991;Sharkey, 1993;Volberding, 1985;Young et al, 1988). Table 1 summarizes the roles and care practices of most key multidisciplinary care providers.…”

“…For example, nurses and dietitians have been identified for their role in initial patient assessment (Harrow, et al, 1994;Howes, 1984;Spirig et al, 2004). Nurses, physicians, and social workers share a supportive role, among other responsibilities (Cicatiello & Perdue, 1994;Howes;Pfeffer & Schnack, 1995;Satterwhite et al, 1991;Spirig et al;Volberding, 1985;Young et al, 1988). Social workers and nurses help navigate patients through the health care system and identify social resources (Nuffer, 1991;Pfeffer & Schnack;Rosner, et al, 1985;Satterwhite, et al;Spirig et al).…”

“…Nursing and psychosocial support staff -counseling. Young et al, 1988 Physicians, nurses, social workers, home care coordinator, clinic coordinator, neurologist, psychologist, nutritionist, speech therapy, developmental specialist. Home environment is assessed on initial visit, referrals made for service.…”

“…In addition, only approximately half of the respondents were in compliance with all suggested utilization outcomes by January 1998, elevated from a mere 29% in 1996, suggesting wide variability in service provision (Shapiro). Poor accessibility and discrimination affecting service provision as referenced in the 1980s (Pascarelli & Holtzworth, 1987;Young, et al, 1988) still poses a challenge to health care providers today (Henry & Costantino, 1996;Shapiro et al;Winn, 1997). Disadvantaged groups are still not receiving timely, high-quality care for HIV (Cummins & Millar, 2004;Shapiro et al).…”