Shaping the Patient-Centered Medical Home to the Needs of HIV Safety Net Patients: The Impact of Stigma and the Need for Trust

J Assoc Nurses AIDS Care. 2018 Nov-Dec;29(6):807-821. doi: 10.1016/j.jana.2018.06.005. Epub 2018 Jun 28.

Abstract

The patient-centered medical home (PCMH) is a promising model for increasing the efficiency and quality of HIV care. We evaluated the implementation of PCMH-related demonstration projects in HIV care settings serving safety net populations. We conducted 113 qualitative interviews with key informants and patients to understand which PCMH components were perceived as best meeting patient medical and support service needs. Our results demonstrate the value and limitations of the PCMH, as currently conceived, for HIV care settings. Clinics focused on modifying workflows and improving care coordination. Patients welcomed such changes because they reinforced existing trust in the providers. Clinics dedicated less attention to promoting patient activation, such as building self-management skills, because such changes were seen as duplicative or undermined existing practices to meet patient social support needs. Research should explore how components of the PCMH could be modified to more fully meet the needs of this patient population.

Keywords: HIV; patient-centered medical home; qualitative research; safety net care; stigma; trust.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • California
  • Delivery of Health Care / methods
  • HIV Infections / diagnosis
  • HIV Infections / psychology*
  • HIV Infections / therapy
  • Humans
  • Interviews as Topic
  • Male
  • Outcome Assessment, Health Care
  • Patient Participation*
  • Patient-Centered Care / methods
  • Patient-Centered Care / organization & administration*
  • Primary Health Care / methods
  • Primary Health Care / organization & administration
  • Qualitative Research
  • Quality of Health Care*
  • Safety-net Providers
  • Social Stigma*
  • Trust*