Health department HIV/AIDS prevention

Engaging the Patient in the Referral Process
When referrals are made, the patient’s willingness and ability to accept and complete a referral should be assessed. Referrals that match the patient’s self-identified priorities are more likely to be successful than those that do not; the services need to be responsive to the patient’s needs and appropriate for the patient’s culture, language, sex, sexual orientation, age, and developmental level. For example, adolescents should be referred to behavioral intervention programs and services that work specifically with this population. Discussion with the patient can identify barriers to the patient’s completing the referral (e.g., lack of transportation or child care, work schedule, cost). Accessibility and convenience of services predict whether a referral will be completed. The patient should be given specific information regarding accessing referral services and might need assistance (e.g., scheduling appointments, obtaining transportation) in completing referrals. The likelihood thatreferrals will be completed successfully could possibly be increased if clinicians or other health-care staff assist patients with making appointments to referral services. When a clinician does not have the capacity to make all appropriate referrals, or when needs are especially complex, a case manager can help make referrals and coordinate care. Outreach workers, peer counselors or educators, treatment advocates, and treatment educators can also help patients identify needs and complete referrals successfully. Health department HIV/AIDS prevention and care programs can provide information on accessing these services. Assessing the success of referrals by documenting referrals made, the status of those referrals, and patient satisfaction with referrals will further assist clinicians in meeting patient needs. Information obtained through follow-up of referrals can identify barriers to completing the referral, responsiveness of referral services to patient needs, and gaps in the referral system, and can be used to develop strategies for removing the barriers.
Referral Guides and Information
Preparation for making patient referrals includes 1) learning about local HIV prevention and supportive social services, including those supported by the Ryan White CARE Act; 2) learning about available resources and having a referral guide listing such resources; and 3) contacting staff in local programs to facilitate subsequent referrals। Referral guides and other information usually can be obtained from local and state health department HIV/AIDS prevention and care programs, which are key sources of information about services available locally. Health departments and some managed care organizations are also a source of educational materials, posters, and other pre-vention-related material. Health departments can provide or suggest sources of training and technical assistance on behavioral interventions. A complete listing of state AIDS directors and contact information is available from the National Alliance of State and Territorial AIDS Directors (NASTAD) at http://www.nastad.org. In addition, information can be obtained from local health planning councils, consortia, and community planning groups; local, state, and national HIV/ AIDS information hotlines and Internet websites; and community-based health and human service providers
A patient with newly diagnosed HIV infection comes to your office for initial evaluation. Of the many things that must be addressed during this initial visit (e.g., any emergent medical or psychiatric problems, education about HIV, history, physical, initial laboratory work [if not
BOX 5. Referral resource guide, suggested contents
For each resource, the referral resource guide should specify
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name of the provider or agency;
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range of services provided;
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target population(s);
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service area(s);
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contact names and telephone and fax numbers, street addresses, e-mail addresses;
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hours of operation;
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location;
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competence in providing services appropriate to the patient’s culture, language, sex, sexual orientation, age, and developmental level;
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cost for services;
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eligibility;
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application materials;
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admission policies and procedures;
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directions, transportation information, and accessibility to public transportation; and
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patient satisfaction with services.
already done]), how does one address prevention? What is the minimum that should be done, and how can it be incorporated into this visit?
Assuming no emergent issues preclude a complete history and physical examination during this visit, the following should be done:
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During the history, question how the patient might have acquired HIV, current risk behaviors, current partners and whether they have been notified and tested for HIV, and current or past STDs.
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During the physical examination, include genital and rectal examinations, evaluation and treatment of any current STD, or, if asymptomatic, appropriate screening for STDs.
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Discuss current risk behavior, at least briefly. Emphasize the importance of using condoms; address active injection-drug use.
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Discuss the need for disclosure of HIV serostatus to sex and needle-sharing partners, and discuss potential barriers to disclosure.
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Note issues that will require follow-up; e.g., risk behavior that will require continuing counseling and referral and partners who will need to be notified by either the patient or a health department