cultural competence

It is of interest that primary medical care service sites’ highest reported needs for increased training and support were consistent with topics that provider discussion participants’ described as key barriers to state-of-the-art HIV clinical care.

Discussion participants believed that effective training programs for clinicians would include components to help them initially address patients’ psychological, social and economic barriers to HIV care. Such training programs would serve to equip providers with culturally competent communication and patient teaching skills.

It also was expressed that providers need assistance in knowing how to access non-clinical services for patient referrals to receive further psychological, social and/or economic support for coping with HIV. Finally, participants indicated a need for information that would help them increase awareness of available financial resources that would reimburse them for HIV care services. While specific clinical training needs were seldom voiced as a priority, providers in these discussions perceived that several nonclinical variables are relevant.
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HIV care providers are a good resource for explicating key issues that may be associated with the HIV outcome disparity between ethnic minority and majority groups. The information obtained via survey responses and focused discussions with providers are supported by other findings in the medical literature.

For example, it was perceived that minority providers and recipients are somehow marginalized from wider access to financial resources to supplement HIV care costs. Research shows that inadequate reimbursement is a significant predictor of unwillingness to treat people with HIV. Doctors may be unwilling to accept HIV-infected patients due to their fear of income loss from low reimbursement for HIV treatment services and HIV-negative patient attrition resulting from stig-matic perceptions of receiving care in a medical office where infected patients also receive care. The belief that minority providers have limited access to financial incentives for HIV care services is compounded by the perception that many minority HIV-infected patients seek treatment from providers who are not knowledgeable about state-of-the-art HIV therapies. Indeed our findings are supported by Rawlings, Grimes and Easling who found that almost half of the African-American physicians they surveyed either had no experience or a maximum of five years experience treating HIV-positive patients.

Another perception was that patient understanding, psychological acceptance, comfort, and treatment adherence are linked to improved provider sensitivity and cultural competence. Richter, Michaels, Carlson and Coates’ study of motivators and barriers to combination therapy use suggests that the doctor-patient relationship does play a role. They found that more than 50 percent of patients on HIV therapy were encouraged to start treatment by their physician.
However, African-Americans may be unlikely to be influenced by physician recommendations to start HIV treatment. The Kaiser Family Foundation noted that in a national survey, African Americans reported a low likelihood of discussing their HIV test results with a health professional.

In some cases, cultural competence – understanding patients’ needs, providing acceptance, psychological support and a comforting environment – may require extreme dedication from providers to help special populations like substance abusers overcome treatment adherence barriers and improve clinical outcomes. Previous investigators found that provider stereotypes about groups at high risk of HIV infection appear to be related to whether physicians accept HIV-infected patients or prescribe state-of-the-art HIV therapy to their patients.

Our findings using two methodologies – survey and focused discussions – supported by similar conclusions noted in the existing professional literature validate the importance of considering nonmedical factors as pertinent contributors with HAART to the clinical outcomes of minority HIV-infected patients.

Further, we believe our findings serve to help others in HIV provider education to prioritize training needs and issues of concern to African-American clinicians. While the literature has reported on the association between psychosocial cofactors and HIV clinical outcomes, our investigation brings us closer to learning which psychosocial cofactors are paramount for developing a training program for a cross-disciplinary group of African-American providers. canadian pharmacy viagra

IMPLICATIONS

In acknowledgement of limitations, summaries of focused discussions were not developed using independent transcription processes or quantitative measurements to code or rate outcomes.

Rather, the focus group facilitator developed narrative summaries based on review of audio tape recordings and written notes of the discussions. This may have introduced a subjective bias, thereby posing a reliability threat to the discussion findings. Further, a possibility of double counting exists in terms of discussion participants and survey respondents. The latter limitation is believed to be remote since the discussion groups targeted clinicians that treat HIV-infected patients.

In contrast, responses to survey items not described in this paper indicated that the participating medical care service sites had few clinicians that treat HIV-infected patients. Finally, the completion of multiple site surveys by a single individual in several cases may imply that responses were not necessarily independent observations.

Notwithstanding these limitations, the information convergence from focused discussions, medical site surveys and the professional literature gives credence to the accuracy of our conclusion that non-medical barriers impact the clinical care provided to minority HIV/AIDS patients.

Thus, we believe that curriculum programs designed to enhance the clinician’s ability to provide care for HIV-infected patients would do well to supplement state-of-the-art clinical training with learning units on the non-medical correlates of patient health outcomes. tadalis sx

Compatible with these findings, we recommend inclusion of educational content that meets the following cognitive, attitudinal and skill-based objectives in provider training curricula designed to strengthen HTV care expertise.

Cognitive Objectives

–  Improve understanding of processes for patient referrals to non-medical social services in the community or related health systems.

–  Increase knowledge of and access to third party reimbursement venues for HIV care.

–  Increase awareness about the influence of provider communication on patients’ decisionmaking around HAART therapy.

–  Define the roles and responsibilities of general practitioners regarding HIV care services.

–  Describe multiple resources for HTV clinical updates and clinical consultation services.

Attitudinal Objectives

–  Reduce negative stereotypical beliefs about low-income, high-risk and other HIV-infected populations.

–  Reduce fears regarding personal health risks of treating HIV-infected patients.

–  Increase willingness and/or commitment to specialize in HIV care. tadacip

Skill-Based Objectives

– Increase provider capacity to facilitate comprehensive health care services for patients.

–  Increase provider proficiency in culturally competent communication.

–  Increase provider ability to promote patient respect among the entire health care team.

–  Increase provider mastery of accessing expert advice on HTV clinical management issues.