Enhancing Patient Retention in HIV Care: A Quality Improvement Project of the Emory Infectious Diseases Clinic Ryan White HIV/AIDS Program Restricted; Files Only
Walther, Ajay (Spring 2023)
Published
Abstract
Background: While HIV is no longer considered a death sentence due to the availability of highly effective treatments such as Antiretroviral Therapy (ART), patients today still face significant psychosocial barriers to care, particularly those who live in poverty or are of lower socioeconomic status. Retaining these patients in care is critical to achieving viral suppression and slowing the spread of the virus. The Ryan White HIV/AIDS Program at the Emory Infectious Disease clinic aims to provide patients with HIV care and social services if they meet certain criteria. To achieve this aim, traditional methods of patient retention such as phone-based interventions must be analyzed for their effectiveness, which is what this study aims to explore as a quasi-experimental quantitative study.
Methods: The methods used in this study involved chart extractions to examine the differences in patient attendances for HIV care visits between July and October of 2022. Phone calls were made to patients to assess why they missed appointments and comments were qualitatively recorded. Additionally, reminder calls were made to patients for appointments the next day. A numerical code was used during three separate analyses to highlight the frequencies of reasons for missed appointments.
Results: From July to October, the first analysis showed that a majority of patients contacted did not answer the phone (46.15%, 57%, 43.14% and 41.18% for each month). A second analysis conducted only focused on patients who did answer the phone and found that many patients had already canceled or rescheduled their appointments before the call, as well as that patients were either sick or had medical issues that prevented them from showing up. The no-show and appointment attendance rates did fluctuate from month to month, though several clinic staff anecdotally noted that the no-show rate fell during the course of the intervention.
Conclusion: The data collected over the course of four months at the Emory Infectious Disease Clinic in Midtown Atlanta gives a somewhat clearer picture of the kinds of barriers that patients face to being retained in care, but also more importantly shows how many patients are unreachable by phone.
Table of Contents
Chapter 1: Introduction 1
Overview of the Problem 1
Overview of the Project 2
Chapter 2: Literature Review 4
What is HIV & What is The Ryan White Program? 4
HIV 4
The Ryan White Program 5
Treatment Regimen and Continuum of Care for HIV 7
Antiretroviral Therapy 7
The Continuum of Care 8
Barriers & Facilitators to Retention in HIV Care 9
What are the Barriers? 9
What are the Facilitators? 10
The Power of Phone Calls & The Value of Human Interaction 11
Human vs. Non-Human 11
Aspects of Patient Retention - Two Types of Calls 13
Pre-Visit Reminder Phone Calls 13
Follow-Up Calls for Missed Visits 14
Gaps in Literature 15
What More Must Be Done? 15
Chapter 3: Methodology 17
Overview of Methods 17
Basic Structure 17
Setting 17
Population & Timeframe 18
Study Design 18
Intervention 19
Data Collection 20
Analysis Methods & Use of Numerical Codes 21
Analysis of Psychosocial Barriers to Care 21
Analysis Methods for Non-Answering Patients 23
Chapter 4: Results & Analysis 24
Effect of Pre-Visit Reminder Phone Calls 24
Results of Psychosocial Barriers to Care 24
Results for Non-Answering Patients 28
Effect of Intervention on Appointment Attendance Rates 30
Rate of No-Show’s 30
Rate of Arrived Appointments 30
Rate of Appointments Canceled Between 2 and 24 Hours Beforehand 31
Chapter 5: Discussion & Public Health Implications 32
Discussion 32
Summary of the Results 32
Results in Context of the Literature 34
Implications for the Emory Infectious Disease Clinic 35
Limitations of Study 37
Conclusion of Study 38
Implications for Public Health 38
Implications for Future Research 38
Implications for Future Practice 39
Implications for Future Policy 40
Chapter 6: Conclusion 41
References 43
Appendix A 52
Script for Calling Patients Who Missed Appointments 52
Appendix B 54
Script for Calling Patients to Remind of Appointments 54
About this Master's Thesis
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File download under embargo until 18 May 2025 | 2023-04-19 10:05:57 -0400 | File download under embargo until 18 May 2025 |
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