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APHA Scientific Session and Event Listing

Recorded presentation

Sharon M. Coleman, MS, MPH¹, Chris Grasso, MPH², Judy Y. Tan, BA², and Judith Bradford, PhD². (1) The Fenway Institute, Fenway Community Health, 7 Haviland Street, Boston, MA 02115, 617-927-6453, SColeman@Fenwayhealth.org, (2) The Fenway Institute, Fenway Community Health Center, 7 Haviland Street, Boston, MA 02115

Background: This innovative study examines reasons for attrition in a population of HIV-infected individuals who had been receiving primary medical care at an urban, federally-qualified community health center (FQHC).

Methods: Patients were characterized as lost to follow-up (LTF) if they had not returned to our facility for a primary care visit for 1 year or more. 495 patients were determined LTF between 2001 and 2004. Through a review of the Social Security Death Index, deceased patients were identified. All other LTF patients were contacted for a telephone or mail survey with specific questions to elicit reasons why a patient would discontinue care.

Results: Sixty-nine of the 495 patients were deceased and 15% were ineligible secondary to incarceration or unobtainable contact information. 179 surveys were completed which represents a Council of American Survey Research Organization (CASRO) response rate of 51%. Thirty percent of those surveyed reported relocation as a reason for discontinuing care, 22% received sporadic care elsewhere with gaps in care of 6 months or longer, and 8% reported no regular provider for HIV. Other barriers contributing to LTF included: personal/cultural (poor engagement with provider, clinic atmosphere, concerns of stigma), structural (transportation/parking issues), and financial.

Conclusions: A limitation of our study is the use of self-report data and inherent issues of interpretation. Nevertheless, direct patient feedback indicates areas for organizational self-analysis to effect operational changes that minimize barriers to care. Additionally, more robust methods are needed to assist patient engagement and retention in HIV primary care.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• List three barriers to engagement in HIV primary medical care.
• Evaluate the strengths and weaknesses of a patient survey.
• Reproduce the methodology for similar organizational self analysis on health care delivery, retention, and outreach interventions.

Keywords: HIV/AIDS, Quality Improvement

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation