Focused Discussions

The NMAETC conducted nine focused discussions with providers and held one provider panel presentation between February 2000 and February 2001 in the cities where each of the NMAETC collaborating historically black medical schools are located: Howard University College of Medicine (Washington, DC);

Morehouse School of Medicine (Atlanta); Meharry Medical College (Nashville) and Charles R. Drew University of Medicine and Sciences (Los Angeles).

Convenience samples of physicians, dentists, physician’s assistants, nurse practitioners, nurses, clinical pharmacists and other health professionals who attended an NMAETC sponsored presentation on an HIV-related clinical topic were asked to remain beyond the lecture to participate in the discussion. Focused discussions were conducted immediately following the clinical presentation with those who opted to participate. In lieu of signed consent forms, the Institutional Review Board (IRB) for Human Subjects Research located at NMAETC’s evaluation center at the University of Maryland approved the distribution of information sheets.
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Table 1: SAMPLE TOPIC QUESTIONS FOR FOCUSED DISCUSSIONS WITH PROVIDERS

Why do you think there is a large disparity between the clinical outcomes of minority HIV-infected patients and the white HIV-infected population?

What could the NMAETC do to get more minority providers involved in HIV care?

What are the priority continuing medical education needs regarding the HIV care of minority patients?

What types of education would expand your ability to care for HIV in minority patients?

The information sheets described the voluntary and anonymous nature of discussion participation and emphasized that discussion participants could leave the discussion at any time. They also informed participants that the discussions would be audio-taped for evaluation purposes only.

Discussion facilitators explained the information sheet to the participant groups prior to beginning each discussion session. In addition, participants were asked to complete and submit anonymous forms that asked for personal and professional demographic data. Completion of participant information forms was voluntary. The participant information forms were approved by the University of Maryland’s IRB. A trained facilitator using a standard topic guide led the discussions (Table 1) and subsequently, based on written notes and audiotapes, developed a written transcript and narrative summary of each discussion. Thematic topics that were emphasized by multiple participants and emerged across multiple discussion sessions were noted.

Table 2: Survey Items Assessing Clinics’ Access to Training/Support Services

Question Yes    No Don’t Know
Do providers in your health care delivery site have access to the necessary spe­cialty referrals for HIV-infected clients such as ophthalmology, cardiology, dental care, or mental health? 1        2 CO
Do providers in your health care delivery site have access to foreign language translators during the clinical visits of patients? CM 3
Do providers in your health care delivery site have access to case managers and/or social workers that can help clients with complex life situations improve adherence to HIV therapies? 1        2 CO
Based on your observations, are ethnic minority clients as comfortable as other clients in accessing services at your health care delivery site? CM 3
Has your health care delivery site successfully secured funding for the care of underserved minority clients? 1        2 CO
Would providers in your health care delivery site benefit from further training in HIV therapy and therapy adherence issues? CM CO

Univariate analysis of self-report data obtained from 266 participant information forms received across 10 sessions and notwithstanding repeat attenders revealed that the majority of discussion participants were female (83 percent) and African-American (76 percent).

Participants were comprised of nurses and nurse practitioners (53 percent), physicians (12 percent), dentists (8 percent), physician assistants (6 percent), and clinical pharmacists (1 percent). The remaining 20 percent were from various other health and non-health professions. Professionals from disciplines not primarily tar¬geted often attended NMAETC training meetings and identified their profession as “other” using the standardized participant information forms provided. Based on introductions that occurred prior to audio-taping, it was regularly noted that the majority of the “other” professionals served in a non-clinical role in HIV-AIDS service delivery. cialis canadian pharmacy

Mailed Surveys

In addition to conducting focused discussions, the NMAETC administered mailed surveys to primary medical care organizations identified using the 1999 Primary Care Programs Directory and the HRSA HIV/AIDS Bureau’s roster of Ryan White Title III and Title IV funding recipi­ents. Each targeted primary medical care organi­zation was located in the same cities where the above-mentioned discussions were conducted.

Prior to mailing surveys, NMAETC evaluation staff telephoned the targeted organizations to verify their current addresses and obtain the name and contact number for an appropriate clinician or clinic administrator to complete the survey on the providers’ behalf.

Several organizations had multiple medical care service sites within a target city. In these cases, each eligible medical care service site within an organization was included and received a separate survey. Medical care service sites that were listed in the directory/rosters but were confirmed to be no longer operational or for which a current phone listing could not be obtained were excluded from the sample and did not receive a survey. In total, 12 sites were excluded. generic cialis uk

The remaining 69 medical care sites were identified to receive a survey packet that included a cover letter explaining the purpose of the survey, the confidential and voluntary nature of participation, the mission of the NMAETC, instructions for completing and returning the survey to the evaluators, and a phone number and e-mail address to use if participants had any questions.

Also included were a blank survey, and stamped, self-addressed return envelope. Before mailing, each survey was coded with a confidential number to help evaluators track responses and follow-up with non-respondents to verify that they received the mailing as well as to later assist with subgroup analyses. To sites that were non-respondent after two weeks from the mail date, researchers placed follow-up calls to verify receipt of the survey, encourage participation, offer to re-mail the survey packet, if needed, or to have an interviewer administer the survey over the telephone.

Table 3: SURVEY ITEMS ASSESSING NEED FOR FURTHER TRAINING/ SUPPORT SERVICES

Question Def. Yes Prob. Yes Prob. No Def. No
Would providers in your health care delivery site benefit from having better access to the necessary specialty referrals for HIV-infected clients such as oph­thalmology, cardiology, dental care, or mental health? 1 2 3 4
Would your health care delivery site benefit from having better access to for­eign language translators during the clinical visits of patients? 1 2 3 4
Would providers in your health care delivery site benefit from having better access to case managers and/or social workers that can help clients with com­plex life situations improve adherence to HIV therapies? 1 2 3 4
Would providers in your health care delivery site benefit from hearing about ways in which others have made their health services more comfortable and accessible to ethnic minority clients? 1 CM 3 4
Would your health care delivery site benefit from training on how to secure funding for the care of under-served minority clients? 1 CM 3 4
Would providers in your health care delivery site benefit from further training in HIV therapy and therapy adherence issues? 1 2 3 4

The survey contained five items that assessed current access to specific support services offering “yes” > “no”, or “don’t know” as response options (Table 2). Another six items assessed perceptions about the benefit of additional access to each of the specific support services and about the benefit of receiving further training in HIV therapy and therapy adherence issues. Response choices for those six items were “definitely yes”, “probably yes”, “probably no”, and “definitely no” (Table 3). Univariate analysis was used to characterize the prevalence of perceived access to support services and benefit for increased access to support services and training. The survey, cover letter and data collection protocol each was approved by the University of Maryland’s Institutional Review Board for Human Subjects Research. Apcalis Oral Jelly

Of the 69 organizational surveys mailed, 41 percent were completed and returned to the evaluators, representing 28 individual medical care sites. Surveys were completed by full-time clinic administrators for 14 of the sites, part-time administrators/part-time clinicians for 10 of the sites, and full-time clinicians for three of the sites. (One respondent did not define his or her organizational role). In some cases, larger organizations deemed it appropriate for one individual to complete a survey for several of their medical care service sites. The majority (57 percent) of the responding sites were Ryan White Care Act funded recipients, implying that they provide services to HIV-infected patients.