 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
|
| The 131st Annual Meeting (November 15-19, 2003) of APHA |
John B. Wayne, PhD1, Angela Smith, MPH2, and Estelita M. Quimosing, MD2. (1) Health Services Administration, University of Arkansas at Little Rock, 2801 South University Avenue, 202 Ross Hall, Little Rock, AR 72204, (501)569-3385, jbwayne@ualr.edu, (2) Jefferson Comprehensive Care System, Inc, 117 South Cedar, Little Rock, AR 72204
It is well known that HIV/AIDS has disproportionably affected marginalized and stigmatized people across the US. The state exhibits many of the nationwide trends, including an alarming increase in cases among heterosexuals, women & minorities. Due to escalating demand and barriers to care in our service area, Jefferson Comprehensive Care Systems Incorporated received Ryan White Care Act funding to test an innovative delivery model designed to strengthen resiliency factors among people living with HIV and to reduce access barriers to necessary medical and supportive care services.
The project was designed to evaluate the impact of two enhanced health care delivery models for HIV+ clients compared to a traditional ambulatory health care delivery model. Clients in the “traditional” health care delivery group received treatment at a rural Community Health Center. Clients in the “blended” health care delivery group received treatment at an urban Medical Center. Although not the principle focus, the project provided a natural study of urban-rural differences in client characteristics, their service needs and their response to systems level interventions.
One hundred sixty-three individuals are included in the study. The urban and rural clients had the expected demographic characteristics. Overall, they were 68.7% male and 68.1% African American. They had a mean age of 37.2 and a mean education of 12.2 years. The differences include: 1. Rural clients were significantly less likely to be gay or lesbian. 2. Although similar percentages were employed, urban clients were significantly more likely to be working full-time with insurance while rural clients were working part-time without insurance. 3. Urban clients were less likely to use condoms. 4. Urban clients had more mental health needs but had the same utilization and experienced the same barriers. 5. Rural clients experienced greater barriers to medical care services. 6. Rural clients were significantly more likely to use alternative therapists for care. 7. Specialized AIDS housing did not exist in the rural area. Rural clients were more likely to need housing assistance. 8. Over 50% of both groups needed financial assistance. This is both a rural and urban problem. 9. Rural clients had greater need for food/groceries, child care, transportation and legal services. 10. Rural clients were more likely to report that they take their medications as prescribed.
One hundred twenty-one clients were available at follow-up. Enhanced case management tailored to the urban/rural differences reduced barriers, increased access, and improved outcomes.
Learning Objectives:
Keywords: Rural Health Care, HIV/AIDS
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Health Resources and Services Administration,
Jefferson Comprtehensive Care Systems,
The University of Arkansas for Medical Sciences,
The University of Arkansas at Little Rock
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: grants, employment