AIDS - Case Management

J Health Care Poor Underserved 1999 Aug;10(3):313-27

Relationship between ambulatory care accessibility and hospitalization for persons with advanced HIV disease.

Laine C, Markson LE, Fanning TR, Turner BJ

Thomas Jefferson University, USA.

Specific features of ambulatory care, such as accessibility, may influence hospital use for patients with HIV infection. To identify clinic features associated with a lower risk of hospitalization, 6,280 New York state Medicaid enrollees diagnosed with AIDS in 1987-1992 and managed by one of 157 surveyed clinics were studied. The odds of hospitalization in the year before AIDS diagnosis were associated with five clinic features that facilitate the accessibility of care: (1) evening/weekend hours, (2) case manager, (3) appointments within 48 hours, (4) telephone consultation, and (5) whether the clinic handled urgent care. Hospitalization in the year before AIDS diagnosis occurred for 49 percent of patients. Three of the five accessibility features had unadjusted associations with lower hospitalization rates. The adjusted odds of hospitalization were lower for patients in clinics with extended hours (OR = 0.77, 95% CI = 0.63, 0.93) and for patients in clinics with four or more accessibility features compared with those in clinics with less than two features (OR = 0.67; 95% CI = 0.50, 0.89).

PMID: 10436730, UI: 99365783

Health PAC Bull 1990 Winter;20(4):32-3

Case management: a new solution for caring for people with AIDS?

Freudenberg N

PMID: 10109325, UI: 91153950

Dermatol Clin 1998 Oct;16(4):655-8, ix

Sexually transmitted diseases. Management and prevention strategies around the world.

Waugh MA

Department of Sexual Health, General Infirmary, Leeds, United Kingdom.

Since 1982, the advance of HIV/AIDS infection has radically altered the management of STDs around the world. Prevention, especially in developing countries is paramount. A scientific basis for treatment coupled with epidemiology and case management is required. Discussion to the merits of different forms of treatment, classical clinical, etiological and syndromic management, and their evaluation, is described.

PMID: 9891662, UI: 99108811

AIDS Care 1998 Aug;10(4):481-503

The integration of informal care, case management and community-based services for persons with HIV/AIDS.

London AS, LeBlanc AJ, Aneshensel CS

Department of Sociology, Kent State University, Ohio 44242-0001, USA. alondon@kent.edu

This research examines the integration of informal and formal care for persons with HIV/AIDS. Data come from a panel survey of informal HIV/AIDS caregivers (N = 642) and are analyzed using a modified version of the Behavioral Model that allows for inclusion of predisposing, enabling and need characteristics of persons with HIV/AIDS and their caregivers. The outcome component of our model emphasizes the role of case management as an intermediary service designed to facilitate linkage to other services. Results indicate: substantial use of case management and other services among persons receiving informal care; characteristics of care recipients, caregivers and dyads directly influence case management and service use; case management positively influences service use at baseline and change in service use over time; and the association between case management and service use generates indirect influences on service use related to characteristics of care recipients, caregivers and dyads. These results highlight the importance of case management as a mechanism for integrating informal and formal care and demonstrate that service utilization is influenced by the social context of illness.

PMID: 9828968, UI: 99046408

AIDS 1998;12 Suppl 2:S57-65

Indicators and the measurement of STD case management in developing countries. STD PI6&7 Working Group.

Saidel TJ, Vuylsteke B, Steen R, Niang NS, Behets F, Khattabi H, Manhart L, Brathwaite A, Hoffman I, Dallabetta G

AIDS Control and Prevention Project, Family Health International, Arlington, Virginia, USA.

The paper reviews methodologies for measuring quality of sexually transmitted disease (STD) case management through facility based assessments. These include observations and interviews of providers, as promoted by the World Health Organization's Global Programme on AIDS, and some of the viable alternatives including patient exit interviews, mystery patients, record review and patient encounter forms with supervisory visits. The paper concludes that the alternative approaches are feasible in resource poor settings and that they provide crucial data for evaluation and continued program development.

Publication Types:

• Review
• Review, tutorial

PMID: 9792362, UI: 99006848

J Adolesc Health 1998 Aug;23(2 Suppl):96-106

Seattle YouthCare's prevention, intervention, and education program: a model of care for HIV-positive, homeless, and at-risk youth.

Tenner AD, Trevithick LA, Wagner V, Burch R

YouthCare, Seattle, Washington 98105, USA.

YouthCare's project for youth who are human immunodeficiency virus (HIV)-positive or at high risk for becoming HIV positive is one of 10 supported by Special Projects of National Significance Program, HIV/Acquired Immunodeficiency Syndrome Bureau, Health Resources and Services Administration. Throughout its 23-year history, YouthCare has focused on serving runaway, homeless, sexual minority, and other youth "on the margins." To respond effectively to the needs of these youth, YouthCare has developed creative service approaches including involving youth in program design and taking the programs to where the youth live. Building on this experience, the agency developed a continuum of services which has provided care to 906 youth, including 37 who are HIV positive. The five major elements of the model include: (a) youth-specific HIV antibody test counseling, (b) outreach, (c) intensive case management for HIV-positive youth, (d) prevention services for youth at high risk of HIV infection, and (e) peer involvement. Quantitative evaluation helped in identifying youth served by the project (e.g., over one third self-identify as a sexual minority) and the sites at which services should be provided. Preliminary results from qualitative evaluations have stressed the importance of teamwork in designing clinical interventions and providing support to direct-service staff. This report's conclusion stresses that case management for this population, even though time and resource-intensive, is effective, and that services need to be flexible and tailored to each client's needs.

PMID: 9712257, UI: 98376075

J Adolesc Health 1998 Aug;23(2 Suppl):83-95

Indiana Youth Access Project: a model for responding to the HIV risk behaviors of gay, lesbian, and bisexual youth in the heartland.

Wright ER, Gonzalez C, Werner JN, Laughner ST, Wallace M

Department of Sociology, Indiana University Purdue University Indianapolis, 46202-5140, USA.

The Indiana Youth Access Project (IYAP) is supported by the Special Projects of National Significance Program, Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) Bureau, Health Resources and Services Administration. The IYAP is a model HIV care program being developed at the Indiana Youth Group, Inc. (IYG) in conjunction with the Indiana State Department of Health and Indiana University. Previous studies indicate that gay, lesbian, and bisexual youth are at increased risk of acquiring HIV because of the stigmatization and social marginalization they experience as a result of their sexual identities. During the course of the first 3 years of the demonstration, the program has served 418 young people, including nine who are HIV infected. The IYAP targets the special needs of this special population by confronting institutional barriers which limit these young people's access to HIV care services, assisting them in building stronger peer support networks, and providing them with professional case management and related services. The model builds upon the successful peer-support program established at IYG by incorporating a unique set of health, mental health, and social case-management services provided by trained professionals. In addition, the program incorporates an extensive peer-counselor training and outreach program which targets street youth and other at-risk young people. The program has provided education and training workshops on the special needs of gay, lesbian, and bisexual youth to thousands of health care, education, and social service professionals both in central Indiana and around the nation.

PMID: 9712256, UI: 98376074

J Adolesc Health 1998 Aug;23(2 Suppl):59-70

Childrens Hospital Los Angeles: a model of integrated care for HIV-positive and very high-risk youth.

Schneir A, Kipke MD, Melchior LA, Huba GJ

Childrens Hospital Los Angeles, California 90054-0700, USA.

Childrens Hospital Los Angeles (CHLA) provides an integrated care model for youth with and at high risk for human immunodeficiency virus (HIV) infection, through a grant from the Special Projects of National Significance Program, HIV/acquired immunodeficiency syndrome (AIDS) Bureau, Health Resources and Services Administration. The project has provided outreach to 8400 youth at risk and has provided clinical services to 296 young men (16.6% HIV positive) and 352 young women (9.1% HIV positive). Situated within the Division of Adolescent Medicine at Childrens Hospital Los Angeles, the project consists of a general medical clinic for youth along with psychosocial services including case management, counseling, and related ancillary services. A key part of the model is to provide health services within a general medical clinic for youth where participation in the clinic does not serve to identify a youth to his or her peers in the waiting room as having HIV. Another key part of the model is to provide extensive outreach within the community including contacts at bars and social clubs where high-risk youth congregate, on the street, and through the social networks of youth already identified as having HIV who participate in the CHLA clinics. In the last 2 years of the program, the peer outreach component has been strengthened and peer support activities have also been implemented. The program also has developed a Computer-Assisted Adolescent Referral System (CAARS), available on diskette and on the Internet, for the referral of youth to services in the Hollywood area.

PMID: 9712254, UI: 98376072

J Adolesc Health 1998 Aug;23(2 Suppl):5-10

Overview of the Special Projects of National Significance Program's 10 models of adolescent HIV care.

Woods ER

Division of Adolescent/Young Adult Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.

Ten models of adolescent human immunodeficiency virus (HIV) care were funded in 1993 by the Special Projects of National Significance (SPNS) Program, HIV/Acquired Immunodeficiency Virus (AIDS) Bureau, Health Resources and Services Administration, through the Ryan White CARE Act. These models were supported to advance knowledge about the engagement of HIV-positive and at-risk adolescents and young adults in care. This article provides an overview of the SPNS Program's adolescent initiative, which developed and evaluated innovative models of HIV care, and provides background information on and summarizes the 10 models of care. The models are organized into four groups emphasizing different concepts: (a) youth involvement; (b) outreach to bring youth into services; (c) case management and linkage to services; and (d) a comprehensive continuum of care for youth.

PMID: 9712249, UI: 98376067

J Public Health Manag Pract 1998 Jul;4(4):87-96

The development of a comprehensive interdisciplinary HIV/AIDS center: a community needs assessment.

Baldwin KA, Marvin CL, Rodine MK

University of Illinois, Peoria, USA.

Meeting the needs of HIV-infected patients in a focused, cost-efficient, coordinated manner is one of the most challenging problems in health care today. Before developing an intervention program, accurate surveys of need must be done. This article presents one such needs assessment conducted in a rural section of the Midwest. The assessment consisted of (1) surveys of HIV+ individuals/people with AIDS, area physicians, and local key informants and service providers, and (2) statistical data from health departments. Results of analyses suggest that access to primary care, self-care education, mental health and family support services, case management, financial assistance, community education, and home health services are this community's highest priority needs.

PMID: 10186765, UI: 98431040

J Volunt Adm 1997 Winter;15(2):30-5

A volunteer program at a supportive residence for people with AIDS.

Gilligan N

Alexian Brothers Bonaventure House, Chicago, IL, USA.

Bonaventure House in Chicago is one of two adult licensed supportive residences in the State of Illinois for people living with AIDS. Residents have access to medical case management, pastoral care, social workers/counselors, and recovery programs for substance addiction. Over 120 volunteers provide practical and supportive services for the residents. This article reports on management procedures and challenges faced by the Bonaventure House volunteer program.

PMID: 10164935, UI: 97191928

J Assoc Nurses AIDS Care 1997;8 Suppl:24-8

The case manager's role in adherence.

Wolfe GS

Physician Disease Management, Washington, DC, USA.

The nurse as case manager has a responsibility to help patients become fully informed before making decisions about specific antiretroviral therapy regimens. In addition, the case manager can help patients assess their current situation with regard to the possibility of taking and adhering to complex antiretroviral regimens. For the patient who is currently taking antiretroviral therapy, the case manager is the point person who oversees continuity of care and ensures communication among all of the patient's health care providers.

PMID: 9356959, UI: 98019807

J Case Manag 1997 Summer;6(2):43-50

Peer intervention in case management practice.

Albrecht GL, Peters KE

School of Public Health, University of Illinois at Chicago 60612, USA.

Using peers as case managers in dealing with current and chronic public health problems such as substance abuse, gang violence, or the HIV/AIDS crisis has been shown to improve outreach efforts, monitoring, and outcomes in hard-to-reach populations. This article focuses on a case management strategy that uses peer modeling interventions to assist people in renegotiating their present life circumstances. Peer modeling engages peers of the client population as case managers and employs group-mediated, social control intervention strategies in the community to bring about positive changes in lifestyle and living conditions. The peer approach is an enhanced version of case management, utilizing the core activities of outreach, assessment, planning, linking, monitoring, and advocacy but adding peer-led, skill-based training activities, coupled with a system of positive incentives designed to encourage a more healthful lifestyle. To clarify this enhanced approach to case management, the authors present a matrix to illustrate how key case management activities might be enhanced through peer modeling interventions. We conclude by suggesting the circumstances in which an organization responsible for service delivery might consider using peer modeling in addressing difficult public health problems, and we discuss the advantages and disadvantages of such a strategy.

Publication Types:

• Review
• Review, tutorial

PMID: 9335723, UI: 97476439

AIDS Educ Prev 1997 Apr;9(2):133-45

Evaluation of HIV/STD prevention, care and support: an update on WHO's approaches.

Mertens TE, Carael M

Chief of Development of Policy and Programme Evaluation, World Health Organization, Geneva, Switzerland.

Over the past decade only a limited number of public health initiatives have been subjected to systematic monitoring and evaluation and, in many instances, there is growing pressure to estimate which approaches work best for a given level of inputs in order to allocate resources effectively. However, evaluation is very often seen as punitive, and a change in perception is needed to allow evaluation to be owned by all stakeholders in public programs. In the field of HIV/AIDS prevention and care, the first difficulty is that many national AIDS programs lack clearly stated objectives and involve a wide variety of players. These players each have their own guidelines for project/program design, monitoring, and evaluation. The second difficulty relates to the fact that evaluation involves "multiple methods, multiple audiences, multiple funding sources, multiple perspectives, multiple paradigms, multiple roles, and multiple solutions to multiple problems" (Quinn Patton, 1986). To some people, evaluation calls for complex experimental studies while to others it means pausing at the end of an activity to sort out what went well and what went less successfully. This paper examines briefly some of the problems and challenges facing the evaluation of HIV prevention and care and summarizes the approaches adopted by the World Health Organization (WHO) to assist AIDS programs around the world in evaluating their initiatives. The paper also provides an update on the progress of developments, training, and implementation of these approaches.

PMID: 9167799, UI: 97310900

Manag Care Q 1996 Spring;4(2):46-57

Case management: meeting the needs of chronically ill patients in an HMO.

Grower R, Hillegass B, Nelson F

Sierra Health Services, Inc., Las Vegas, NV, USA.

Primary care staff education plays a critical role in a health plan making a transition from a case management model to a model that emphasizes close care coordination for chronically ill patients with multiple care needs. Multidisciplinary teams can help refine the system to have a positive impact on care across diverse settings: Health Plan of Nevada found that such training aids staff in identifying at-risk individuals and in developing plans for preventive health screening activities, medication compliance, and needs assessment.

PMID: 10157261, UI: 96196916

ABNF J 1996 Mar-Apr;7(2):47-53

HIV/AIDS case management: a learning experience for undergraduate nursing students.

Merrill EB

Case management has received national and international recognition as a method for providing comprehensive, coordinated care to clients/families with various health problems, especially HIV/AIDS. With the increase in clients infected with the AIDS virus and the needs of such clients, community health nurses will likely become their case managers since they usually seek care from the public sector. Therefore, students receiving learning experiences in community health nursing will have contact with HIV/AIDS clients and their affected families. Nurses must monitor, coordinate, and manage the care of HIV/AIDS clients within community-based settings. Case management models have been used by community health nurses who provide care to HIV/AIDS clients. In fact, senior nursing students in community health nursing at the Coppin State College Helene Fuld School of Nursing were provided learning experiences with a community health nurse case manager who had a bachelor's degree. Students had to reassess their values, beliefs, and attitudes concerning caring for HIV/AIDS clients and their affected families. Additionally, students used the nursing process and the Levine Model to provide nursing care to clients. Baccalaureate Nursing Programs must provide students with learning experiences as case managers of HIV/AIDS clients/families.

PMID: 8826232, UI: 96423631

J Assoc Nurses AIDS Care 1995 Mar-Apr;6(2):33-40

Community-based HIV case management: challenges and opportunities.

Sowell RL

AID Atlanta, Inc., GA, USA.

Over the past decade, case management has become a popular strategy for the organization and delivery of health service. Yet, in many settings, a lack of clarity exists as to the exact function and process of case management. The author addresses key issues in the debate surrounding case management and provides insight into how these issues can be resolved. The potential of case management in future healthcare restructuring and HIV/AIDS prevention is explored.

PMID: 7599330, UI: 95322608

J Case Manag 1995 Spring;4(1):15-21

Integrated case management: the AID Atlanta Model.

Sowell RL, Grier J

This article describes the integrated case management model being developed by AID Atlanta, Inc., a community-based AIDS service organization. The case management system features centralized supervision and coordination with decentralized delivery of case management services that avoid duplication of services. The model establishes a system that links clients to appropriate levels of service. The integrated model seeks to address the client's physical, psychological, emotional, and spiritual needs across a continuum of care delivery. The cornerstone of the system is the development of standards of service, systematic documentation, and outcome evaluation criteria.

PMID: 7795537, UI: 95315879

J Natl Black Nurses Assoc 1994 Spring-Summer;7(1):36-49

Perceptions of social support of African Americans with acquired immunodeficiency syndrome.

Hudson AL, Morris RI

Visiting Nursing Association of San Diego County, California, USA.

Using the grounded theory methodology with symbolic interactionism as the theoretical framework, this study explores the perceptions of support systems that exist for African Americans with AIDS. A convenience sample of five African Americans with AIDS was interviewed and the data analyzed using constant comparative analysis. Seven themes emerged: (a) independence and control over one's environment, (b) support from significant others, (c) keeping a positive attitude, (d) spirituality, (e) lack of family support, (f) appreciation for case management, and (g) avoidance of support groups. The analyses and conclusion derived from these themes have many implications for nursing, the most important being the need for education preparation of professional nurses as case managers.

PMID: 9128524, UI: 97274434

Rev Sanid Hig Publica (Madr) 1994 Mar-Apr;68(2):261-5

[Sociomedical syndrome. Intervention strategies to manage a new public health problem].

Castano Barroeta C, Cossent Aguinaco L, Martinez Alonso C

Unidad Geriatrica, Hospital de la Cruz Roja Espanola, Gijon.

Medical and social services are confronted with the increasing demands that our ageing society presents. Some patients (specially geriatric, chronically disabled and oncologic patients) pose multiple needs of social and medical care that very often are not met in a coordinated and comprehensive way. In this work authors present case management as a tool to achieve a better organization of social and medical resources in accordance with the demands of this growing part of the population.

PMID: 7536339, UI: 95232392

J Case Manag 1994 Summer;3(2):51-5

Nurse case management: collaborative beyond the hospital walls.

Swindle DN, Weyant JL, Mar PS

In 1989, St. Joseph Medical Center initiated a community-based nursing case management program with two nurses providing care to high-risk, chronically ill, frail elderly patients. This program has expanded to five registered nurses actively following over 120 patients. Target populations now served have expanded to include: frail elderly, high-risk pregnant women, premature infants, AIDS patients, and those with chronic physical and mental illness. The nurse manages and coordinates the care for patients through all settings (community and hospital), brokering services, acting as a patient advocate, and giving traditional hands-on care as needed. Outcomes analysis has shown that, after nursing case management intervention, the patients demonstrated a 71% decrease in admissions to the medical center, a 21% decrease in length of stay, and a 64% decrease in Emergency Room usage. Nursing case management helps to prevent patients' health problems from becoming more complex. Consequently, managing their health effectively requires fewer, less costly resources while achieving improved patient outcomes.

PMID: 8000323, UI: 95093369

Soc Work 1993 Jul;38(4):380-7

A community-based approach to HIV case management: systematizing the unmanageable.

Indyk D, Belville R, Lachapelle S, Gordon G, Dewart T

Mount Sinai School of Medicine, New York, NY 10028.

This article presents an analysis and typology of community-based care for a young Hispanic mother with acquired immune deficiency syndrome (AIDS). It develops a conceptual framework that examines retrospectively the needs generated by AIDS over time, the appropriateness of the services, and an assessment of the interventions. Community-based case management can effectively address some of the diverse and changing needs of AIDS patients and their families, such as bridging service gaps and fortifying patient and system strengths while minimizing their weaknesses. Community-based case managers may also be better equipped than hospital case managers to work with difficult patients and coordinate community- and hospital-based care. Conclusions are presented regarding the definition and implementation of community-based, culturally sensitive, family-centered human immunodeficiency virus case management, as well as the importance and difficulty of developing relationships among the family, health care providers, and institutions within the community.

PMID: 8362273, UI: 93369666

Int Nurs Rev 1992 May-Jun;39(3):83-9

Linking primary health care and self-care through case management.

Holzemer WL

School of Nursing, University of California, San Francisco.

Primary health care (PHC) strategies have heightened health care providers' awareness of the need to understand their communities and provided knowledge on how to mobilize communities for health. Orem, a nurse theorist, has developed a similar philosophical position on mobilizing individuals for self-care, which complements PHC theory at the community level. This article links the philosophies and strategies of PHC with self-are and proposes a delivery model of case management, drawing on examples from the HIV/AIDS pandemic and the aging population to illustrate the type of coordinating activities required of case managers in the 21st century.

PMID: 1639590, UI: 92348120

Soc Work Health Care 1992;17(2):27-40

Obstacles to effective case management with AIDS patients: the clinician's perspective.

Roberts CS, Severinsen C, Kuehn C, Straker D, Fritz CJ

H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa 33682-0179.

A social work clinician filled the role of case manager with multiple functions of discharge planner, client advocate, counsellor and educator in her work with a young male AIDS patient and his family. Material from this case is used to illustrate seven problem areas identified as obstacles to effective case management: (1) The stigma of AIDS and homosexuality (2) Lack of adequate family support (3) Impact of AIDS dementia (4) Ethical dilemmas in discharge planning (5) Conflicts in the advocacy process (6) Lack of adequate resources and (7) Countertransference issues. Clinical observations are integrated with the existing social work literature which focuses on providing services to AIDS patients.

PMID: 1440113, UI: 93068641

NIDA Res Monogr 1992;127:167-80

Case management to enhance AIDS risk reduction for injection drug users and crack cocaine users: practical and philosophical considerations.

Falck RS, Siegal HA, Carlson RG

Department of Community Health, Wright State University School of Medicine, Dayton, OH 45435.

The AIDS intervention model described herein represents a new "mixed" model of case management, one that combines AIDS risk-reduction education with a modified version of the traditional broker of services model. The case management component of the model is designed to heed and address those immediate needs that may distract a person from attending to the AIDS risk-reduction messages. The educational component of the model can help a person develop interest in the case management services. The result is a model that, theoretically, can have a greater impact than either component alone would have. The advantages of the model are its flexibility, its ability to quickly assess and address clients' concerns, and its short duration that enhances the likelihood that drug users will complete the process.