title: Impact of service delivery model on health care access among HIV-positive women in New York City.
abstract: As the New York City HIV=AIDS epidemic began generalizing beyond traditionally high-risk groups in the early 1990s, AIDS Service Organizations (ASO) sought to increase access to medical care and broaden service offerings to incorporate the needs of low-income women and their families. Strategies to achieve entry into and retention in medical care included the development of integrated care facilities, case management, and a myriad of supportive service offerings. This study examines a nonrandom sample of 60 HIV-positive women receiving case management and supportive services at New York City ASOs. Over 55% of the women interviewed reported high access to care, 43% reported the ability to access urgent care all of the time and 94% reported high satisfaction with obstetrics=gynecology (OB=GYN) care. This held true across race=ethnicity, income level, medical coverage, and service delivery model.Women who accessed services at integrated care facilities offering onsite medical care and case management=supportive services perceived lower access to medical specialists as compared to those who received services at nonintegrated sites. Data from this analysis indicate that supportive services increase access to and satisfaction with both HIV and non-HIV-related health care. Additionally, women who received services at a medical model agency were more likely to report accessing non-HIV care at a clinic compared to those receiving services at a nonmedical model agencies, these women were more likely to report receiving non-HIV care at a hospital.
authors.affiliation: Center for Health, Identity, Behavior & Prevention Studies, Steinhardt School of Culture, Education and Human Development, New York University, New York, New York 10003, USA.
authors.forename: Nandini V
authors.initials: NV
authors.lastname: Pillai
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Kupprat
authors.forename: Perry N
authors.initials: PN
authors.lastname: Halkitis
mesh_terms: D019090:Case Management / Q000458:organization & administration; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006801:Humans; D008875:Middle Aged; D017146:Models, Organizational; D009519:New York City / Q000453:epidemiology; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data; D015397:Program Evaluation; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology; D012189:Retrospective Studies; D012944:Social Support; D011795:Surveys and Questionnaires; D014930:Women / Q000523:psychology*; D014932:Women's Health Services / Q000458:organization & administration*