Determining barriers to continuity of care in a federally qualified health center (FQHC)

Background: Continuity of care is linked to improved health outcomes and survival rates for persons living with HIV/AIDS, and mitigation of barriers to retention is vital to provide optimal health services to patients. There is a need to elucidate barriers from the patient and provider perspective in a federally qualified health center where financial challenges are largely absent. Methods: In-person interviews, telephone and mailed surveys were used to identify the challenges of engaging in and remaining in care. Assessment of the barriers faced, the extent to which the barrier is faced, and proposed solutions from patients and providers were considered using a standardized questionnaire for the three different delivery methods. Quantitative and qualitative analyses were used. Results: This research is in-progress and analysis is incomplete, however, the expected outcome is to provide a quantitative prioritization of barriers based on the frequency and intensity of the issues identified as hindering retention in care. The major barriers identified thus far have been: transportation, perceived financial barriers, stigma, lack of social support, substance abuse, personal beliefs, limited hours of providers, and changes in employment. Conclusion: The recommendations generated from this direct interaction with patients who have been lost to follow up or who frequently cancel appointments will have the potential to improve retention and health outcomes. Further research is needed to determine the most effective methods of improving continuity of care and delivery of services upon implementation.