The impact of ancillary services on primary care use and outcomes for HIV/AIDS patients with public insurance coverage

Abstract

To better understand the impact of ancillary services on access to primary care, utilization of health services, costs and health status of HIV/AIDS patients, we studied adult HIV/AIDS patients eligible for public insurance for low-income people (Medicaid) in eastern North Carolina. Using primary data from a 1997 survey of such patients linked to Medicaid claims, multivariate logit analysis was used to estimate the effect of receiving housing, legal services and substance abuse treatment and of self-reported failure to obtain transportation and child care services on: (a) adequacy and use of primary care; (b) CD-4 counts; (c) viral load; and (d) self-rated health status. Between two-thirds and four-fifths of patients needing ancillary services obtain them. Receipt of housing and legal services were found to have a positive relationship with access to primary care. Difficulties in obtaining transportation and receipt of substance abuse services had a negative relationship with receipt of adequate primary care. On balance, these findings provide some support for continued public funding for various ancillary services to improve patient access to needed primary care. At current funding levels, not all patients needing help appear able to obtain such services.

Health information exchange interventions can enhance quality and continuity of HIV care

“…medical case management) for those who have co-occurring conditions that impact the effectiveness of HIV care [26,27]. Previous research in RWP-funded health clinics suggests receipt of care and support services in RWP-funded health clinics are associated with better engagement in care, retention in care and patient health outcomes [28][29][30][31][32]. However, these same findings also indicate that the improved engagement, retention and health outcomes are not yet at levels that would be considered ideal [30].…”

“…Previous research in RWP-funded health clinics suggests receipt of care and support services in RWP-funded health clinics are associated with better engagement in care, retention in care and patient health outcomes [28][29][30][31][32]. However, these same findings also indicate that the improved engagement, retention and health outcomes are not yet at levels that would be considered ideal [30]. For example, only 45% of patients in RWP-funded clients reported any primary HIV care visits in the past year [28].…”

“…For example, Mugavero et al demonstrated that receipt of case management prior to an initial visit with a provider can improve linkage to care for newly identified HIV-infected individuals [5]. Several demonstration projects, funded under an initiative from the US Health Resources and Services Administration's (HRSA) Special Projects of National Significance (SPNS) demonstrated that case management and patient navigators can improve engagement in care, retention in care, adherence to care and treatment for at-risk HIV-infected individuals [28,30]. Integration of HIV primary care, specialty care and support services, as occurs within the Veterans Administration and Kaiser Permanente, has been shown to improve the quality of care across the entire continuum of care for people with HIV [34][35][36].…”

The Urban Safety Net: Can It Keep People Healthy and Out of the Hospital?

“…Previous research demonstrated a clinical benefit from integrating social services and ancillary care with the medical model. [3][4][5][6][7][8][9][10] However, the findings suggest that the constellation of providers and agencies accessed in Baltimore are not keeping individuals out of emergency departments or from being admitted to the hospital. The significance of being the only city without a CAP grant, a program funded by the Health Resources and Services Administration that builds on existing capacity to help health providers develop integrated systems for the uninsured and underinsured, is unclear.…”

“…3,4 Similarly, communitybased ancillary services provided in coordination with medical care have been shown in many studies to improve the care of patients with acquired immunodeficiency syndrome (AIDS). [5][6][7] Other working examples of this more inclusive model of safety net providers have been reported in maternal and child health care 8 and other areas. 9,10 How the safety net is defined is relevant to the current pressures for cost containment and more efficient utilization of services by poor and uninsured persons.…”