The influence of healthcare financing on cardiovascular disease prevention in people living with HIV.
Adult
Attitude of Health Personnel
Attitude to Health
Cardiovascular Diseases
/ prevention & control
Female
HIV Infections
/ epidemiology
Health Personnel
/ psychology
Healthcare Financing
Humans
Male
Patient Protection and Affordable Care Act
Preventive Health Services
/ economics
Qualitative Research
United States
/ epidemiology
Cardiovascular disease
HIV
Health planning support
Healthcare financing
Prevention
Relative value scales
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
23 Nov 2020
23 Nov 2020
Historique:
received:
17
08
2020
accepted:
16
11
2020
entrez:
24
11
2020
pubmed:
25
11
2020
medline:
24
3
2021
Statut:
epublish
Résumé
People living with HIV are diagnosed with age-related chronic health conditions, including cardiovascular disease, at higher than expected rates. Medical management of these chronic health conditions frequently occur in HIV specialty clinics by providers trained in general internal medicine, family medicine, or infectious disease. In recent years, changes in the healthcare financing for people living with HIV in the U.S. has been dynamic due to changes in the Affordable Care Act. There is little evidence examining how healthcare financing characteristics shape primary and secondary cardiovascular disease prevention among people living with HIV. Our objective was to examine the perspectives of people living with HIV and their healthcare providers on how healthcare financing influences cardiovascular disease prevention. As part of the EXTRA-CVD study, we conducted in-depth, semi-structured interviews with 51 people living with HIV and 34 multidisciplinary healthcare providers and at three U.S. HIV clinics in Ohio and North Carolina from October 2018 to March 2019. Thematic analysis using Template Analysis techniques was used to examine healthcare financing barriers and enablers of cardiovascular disease prevention in people living with HIV. Three themes emerged across sites and disciplines (1): healthcare payers substantially shape preventative cardiovascular care in HIV clinics (2); physician compensation tied to relative value units disincentivizes cardiovascular disease prevention efforts by HIV providers; and (3) grant-based services enable tailored cardiovascular disease prevention, but sustainability is limited by sponsor priorities. With HIV now a chronic disease, there is a growing need for HIV-specific cardiovascular disease prevention; however, healthcare financing complicates effective delivery of this preventative care. It is important to understand the effects of evolving payer models on patient and healthcare provider behavior. Additional systematic investigation of these models will help HIV specialty clinics implement cardiovascular disease prevention within a dynamic reimbursement landscape. Clinical Trial Registration Number: NCT03643705 .
Sections du résumé
BACKGROUND
BACKGROUND
People living with HIV are diagnosed with age-related chronic health conditions, including cardiovascular disease, at higher than expected rates. Medical management of these chronic health conditions frequently occur in HIV specialty clinics by providers trained in general internal medicine, family medicine, or infectious disease. In recent years, changes in the healthcare financing for people living with HIV in the U.S. has been dynamic due to changes in the Affordable Care Act. There is little evidence examining how healthcare financing characteristics shape primary and secondary cardiovascular disease prevention among people living with HIV. Our objective was to examine the perspectives of people living with HIV and their healthcare providers on how healthcare financing influences cardiovascular disease prevention.
METHODS
METHODS
As part of the EXTRA-CVD study, we conducted in-depth, semi-structured interviews with 51 people living with HIV and 34 multidisciplinary healthcare providers and at three U.S. HIV clinics in Ohio and North Carolina from October 2018 to March 2019. Thematic analysis using Template Analysis techniques was used to examine healthcare financing barriers and enablers of cardiovascular disease prevention in people living with HIV.
RESULTS
RESULTS
Three themes emerged across sites and disciplines (1): healthcare payers substantially shape preventative cardiovascular care in HIV clinics (2); physician compensation tied to relative value units disincentivizes cardiovascular disease prevention efforts by HIV providers; and (3) grant-based services enable tailored cardiovascular disease prevention, but sustainability is limited by sponsor priorities.
CONCLUSIONS
CONCLUSIONS
With HIV now a chronic disease, there is a growing need for HIV-specific cardiovascular disease prevention; however, healthcare financing complicates effective delivery of this preventative care. It is important to understand the effects of evolving payer models on patient and healthcare provider behavior. Additional systematic investigation of these models will help HIV specialty clinics implement cardiovascular disease prevention within a dynamic reimbursement landscape.
TRIAL REGISTRATION
BACKGROUND
Clinical Trial Registration Number: NCT03643705 .
Identifiants
pubmed: 33228623
doi: 10.1186/s12889-020-09896-8
pii: 10.1186/s12889-020-09896-8
pmc: PMC7685650
doi:
Banques de données
ClinicalTrials.gov
['NCT03643705']
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
1768Subventions
Organisme : HSRD VA
ID : IK6 HX003161
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23 HL137611
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL142099
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01HL142099
Pays : United States
Références
JAMA. 2019 Sep 9;:
pubmed: 31498373
J Gen Intern Med. 2016 Sep;31(9):1004-10
pubmed: 27138425
Milbank Q. 2020 Mar;98(1):172-196
pubmed: 31994260
Am Heart J. 2019 Oct;216:91-101
pubmed: 31419622
N Engl J Med. 2017 Jul 20;377(3):246-256
pubmed: 28636834
Int J Qual Health Care. 2007 Dec;19(6):349-57
pubmed: 17872937
Prog Cardiovasc Dis. 2020 Mar - Apr;63(2):92-100
pubmed: 32092444
J Biomed Inform. 2019 Jul;95:103208
pubmed: 31078660
Health Aff (Millwood). 2000 Jul-Aug;19(4):149-55
pubmed: 10916968
Clin Infect Dis. 2020 Mar 25;:
pubmed: 32211757
JAMA. 2019 Aug 5;:
pubmed: 31380934
Circulation. 2020 Jul 28;142(4):e42-e63
pubmed: 32567342
Med Care. 1992 Nov;30(11 Suppl):NS1-12
pubmed: 1434963
Top Antivir Med. 2019 Sep/Oct;27(3):91-100
pubmed: 31634860
JAMA. 2018 Jan 9;319(2):119-120
pubmed: 29270611
Circulation. 2019 Jul 9;140(2):e98-e124
pubmed: 31154814
Implement Sci. 2019 May 9;14(1):50
pubmed: 31072409
Prog Cardiovasc Dis. 2020 Mar - Apr;63(2):79-91
pubmed: 32199901
Open Forum Infect Dis. 2017 Jan 31;4(1):ofw240
pubmed: 28480238
J Transl Int Med. 2016 Apr 1;4(1):14-19
pubmed: 28191512
Circulation. 2015 Oct 20;132(16):1580-5
pubmed: 26481563
J Assoc Nurses AIDS Care. 2016 Sep-Oct;27(5):574-84
pubmed: 27080926
Circulation. 2018 Sep 11;138(11):1100-1112
pubmed: 29967196
Qual Res Psychol. 2015 Apr 3;12(2):202-222
pubmed: 27499705
J Gen Intern Med. 2019 Jan;34(1):82-89
pubmed: 30367329
Implement Sci. 2017 Jun 21;12(1):77
pubmed: 28637486