Nursing home residents with HIV and anemia.

This research profiles nursing home residents who have human immunodeficiency virus (HIV) and anemia at the time of admission, utilizing the minimum data set (MDS). In addition, this article compares residents with HIV and anemia to other nursing home residents with HIV. These resident profiles include sociodemographic characteristics, health status measures, and special treatments and procedures received. This study analyzed 1,281 admission assessments for HIV residents with anemia and 3,832 admission assessments for other residents with HIV in the MDS between June 22, 1998 and January 17, 2000. A significantly greater percentage of HIV residents with anemia were female (38.6%) compared to other residents with HIV (27.9% female). Almost two-thirds of HIV residents with anemia and three-quarters of other residents with HIV received Medicaid coverage at the time of their admission to the nursing home. Approximately 3 of every 4 residents with HIV and anemia and other residents with HIV were from racial/ethnic minority groups. Significantly greater percentages of residents with HIV and anemia also had dementia, depression, pneumonia, hepatitis, renal failure, anxiety disorder, and cancer than other residents with HIV. These analyses demonstrate that at the time of admission to the nursing home, those residents with HIV and anemia were significantly more likely to have other diseases, infections, and health care conditions than other residents with HIV. In addition, HIV residents with anemia were significantly more likely to receive special treatments and procedures in the nursing home than other residents with HIV.

Eligibility policies for the state AIDS drug assistance programs.

Drug treatments for HIV infection and related opportunistic infections have had dramatic impacts on the morbidity and mortality associated with HIV disease. HIV drug therapies are essential to the survival and to improved quality of life for individuals with HIV. However, not all people with HIV disease are receiving these medications. The state AIDS drug assistance programs (ADAPs) can provide access to drug therapies for many people with HIV disease who lack adequate drug coverage. This research presents the results of a national survey that identified eligibility-related policies implemented by .48 state ADAPs during 1998 and 1999. The survey assessed the number of people receiving ADAP coverage, the percentage of ADAP beneficiaries who are women, financial and medical eligibility requirements, characteristics of the application process, any implementation of waiting lists, and any coordination of the ADAPs with other public programs.

Analyses of nursing home residents with HIV and dementia using the minimum data set.

OBJECTIVE: The objective of this paper is to profile nursing home residents with HIV who also have dementia at the time of admission, using the Minimum Data Set (MDS). In addition, this paper compares HIV residents with dementia with other residents with HIV. These resident profiles contain sociodemographic characteristics, health status measures, treatments, and procedures. STUDY SUBJECTS: There are 1,074 admission assessments for HIV residents with dementia and 4,040 admission assessments for other residents with HIV in the MDS between June 22, 1998 and January 17, 2000; these were analyzed for this study. RESULTS: Other residents with HIV were twice as likely to be physically independent as HIV residents with dementia. Only 1 of 5 HIV residents with dementia was independent in cognitive skills for daily decision making compared with 3 of 5 other residents with HIV who were independent in these skills. Significantly greater percentages of HIV residents with dementia also had anemia, depression, schizophrenia, cognitive and memory problems, hepatitis, renal failure, and cancer than other residents with HIV. CONCLUSIONS: These analyses demonstrate that HIV residents with dementia were significantly more likely to have other diseases, infections, and health care conditions than other residents with HIV.

The AIDS drug assistance programs and coverage of HIV-related medications.

BACKGROUND: AIDS drug assistance programs (ADAPs) have been implemented in each state to facilitate access to medications for low-income, uninsured, and underinsured people with HIV disease. Policies for each ADAP differ, and these differences influence the access people with HIV have to medications. OBJECTIVE: To compare the coverage of medications and sources of program funding for the state ADAPs. DESIGN: A self-administered mailed survey, sent to administrators of the 50 state ADAPs and the District of Columbia ADAP in December 1998. RESULTS: Forty-nine of the 51 ADAPs (96%) responded to the survey. Title II of the Ryan White Comprehensive AIDS Resources Emergency Act provided a large majority of the funding for the ADAPs, with a number of states also using state funds and/or Title I funds for their programs. The formularies of all ADAPs were nearly identical with respect to coverage of antiretrovirals, but differed in the number and types of other medications included. Some states limited access to medications through waiting lists, enrollment caps, and other policies. Sixteen ADAPs reported that the coverage of protease inhibitors resulted in an appropriation of state government funds to their ADAP, while eight states reported an ADAP budget shortfall. In general, ADAPs in poorer and more rural states included a fewer number of medications on their formularies. CONCLUSIONS: Access to antiretrovirals and other medications is available through state ADAPs, but may be limited in some states due to waiting lists, controls on the enrollment of new beneficiaries, and policies on the number and types of medications beneficiaries may receive.

Midproject findings from a study of the National Collegiate Athletic Association's policy on smokeless tobacco use.

In this paper we present midproject findings from a longitudinal survey of 5,000 male athletes at 56 randomly selected American colleges and universities. The study monitors athletes' compliance with and perceptions of the effects of an organizational policy that restricts smokeless tobacco (ST) use. In 1996 and 1997, 77% of users reported that they complied with the policy during competition. During the same period there was a significant increase in the number of users who complied with policy during practices and of those who credited the policy with contributing to a decline in their overall tobacco consumption (14% vs 68%, p < .001; 17% vs 23%, p < .01: respectively). The findings suggest that organizational policies that regulate ST use can have an impact on young adult ST use.

Assessments of the coverage of HIV-related care by public programs: a survey of AIDS service organizations.

AIDS service organizations (ASOs) were surveyed to identify effective services covered, and effective services not covered, by the Medicaid and Medicare programs, as well as programs funded by Title I and II of the Ryan White CARE Act. The Medicaid programs cover a range of effective health services, with prescription drug coverage mentioned most frequently by the ASOs. In addition to prescription drugs and physician services, the Title II programs offer a range of support-related services. The ASOs identified a blend of health and social services funded by Title I as most effective at meeting the needs of people with HIV illness. The Medicare program covers a range of health services necessary for the treatment of acute illness, except for prescription drugs. The ASOs identified the lack of Medicare coverage of prescription drugs as a major problem for people with HIV illness.

Medicaid policies for the hospice care needed by people with Alzheimer's disease.

This study surveyed the state Medicaid programs and the state affiliates of the National Hospice Organization to identify Medicaid policies that improve the quality of hospice care provided to Medicaid recipients with Alzheimer's disease (AD). Medicaid programs should expand their use of the home and community-based care waiver programs to include specialized services that allow people with AD to remain at home and to assist family members with their care. Among these services are homemaker services, personal care, a range of respite care, home-delivered meals, and companion services. These waiver programs also allow states to establish more generous eligibility standards for waiver services, enabling more people with AD to quality for waiver coverage than would qualify for the traditional Medicaid program.

State implementation of the AIDS drug assistance programs.

Acquired immunodeficiency syndrome (AIDS) drug assistance programs (ADAPs) provide access to medications for people who lack other health coverage. In this article, the authors present the results of a 1997 survey identifying how 48 States implemented ADAPs, focusing on the number of beneficiaries, medical and financial eligibility criteria, the administration of waiting lists, and the coverage of drugs including protease inhibitors. Increased funding for ADAPs is necessary to maintain this important part of the public sector safety net for human immunodeficiency virus (HIV) care.

State-funded medical assistance programs: sources of coverage for HIV-related health care.

Preliminary research found that a number of states implement medical assistance programs (MAPs) funded only with state and/or local government funds. A review of the literature was unable to discover any published research that discusses state-funded MAPs. The objective of this article is to describe these MAPs and to discuss how these programs can be used to provide health services to people infected with HIV who lack other coverage. A two-step survey process was used to identify 20 states implementing MAPs and to identify eligibility criteria, the health services covered, and payment-level policies. Typically, MAPs implement restrictive eligibility policies and set low reimbursement levels for the care covered. However, most MAPs cover a comprehensive range of health services needed by people inflected with HIV, including community-based care and support services.

New perspectives on microbial dehalogenation of chlorinated solvents: insights from the field.

A variety of microbial dechlorination mechanisms have been demonstrated in laboratory microcosms, pure cultures, and in situ sedimentary environments. New perspectives on in situ processes from these efforts allow the design of more realistic bioremediation strategies that complement natural processes regardless of whether the strategy used is one of engineered accelerated bioremediation or natural attenuation. Since 1994 the scientific community has acquired considerable knowledge regarding natural attenuation of organochlorine compounds. Natural attenuation of chlorinated solvents has been documented at a number of field sites. Reductive dechlorination driven by co-contaminants or naturally occurring organics as substrates in combination with aerobic or co-metabolic degradation contains certain chlorinated solvent plumes. Although natural attenuation is not a panacea, at sites where it is applicable, it offers a scientifically sound, cost-effective method to remediate groundwater contaminated with chlorinated solvents.

Support and rewards for scholarly activity in family medicine: a national survey.

BACKGROUND AND OBJECTIVES: This survey examined how time is allotted for family medicine faculty to pursue scholarly activities and how these activities are rewarded. METHODS: A survey was sent to all directors of family practice residency programs (n = 373) and chairs of family medicine departments (n = 112). Four primary questions were asked: 1) How is faculty time allotted for scholarly activities? 2) Does the residency or department use an explicit reward system? 3) What activities are rewarded? and 4) What rewards are used? RESULTS: A total of 363 surveys were returned, for a response rate of 75%. Forty-nine percent of respondents have regular, protected faculty time for scholarly activities. Faculty at university-based residencies and departments were more likely to have protected time (68/93, 73%) than faculty at community-based residencies (93/238, 39%). Thirty-eight percent of respondents have an explicit reward system. Activities rewarded and rewards used are department and program-type specific. CONCLUSIONS: Only 39% of community-based residencies and 73% of university programs allot regular protected time for faculty. The majority of programs and departments do not have an explicit reward system. Further studies are needed to determine if the use of protected time and reward systems enhance scholarly productivity.

Medicaid home and community-based care waiver programs: providing services to people with AIDS.

The authors present the results of a survey demonstrating how Medicaid programs use the home and community-based waiver programs to provide services to people with acquired immunodeficiency syndrome (AIDS) and to other targeted groups. The survey identified a number of waiver services that are effective at meeting the care needs of people with AIDS, such as case management, personal care, respite care, home intravenous therapy, attendant care, hospice, and home-delivered meals. The study demonstrates that in addition to the AIDS-specific waiver program, State Medicaid programs use the home and community-based care waiver programs for the elderly and disabled to provide services to people with AIDS because of their disability status.

Services that nursing facilities should provide to residents with MS: a survey of health professionals.

This study identified care-related services, programs, and equipment that nursing facilities should provide to residents with multiple sclerosis (MS). Two sets of surveys were used to collect the perspectives and opinions of 140 health professionals representing a variety of disciplines. Frequency tabulations of all responses were done by computer for 10 correlated categories to identify the most frequently mentioned services or programs in each category. Stratified frequency tabulations also were done in the medical, rehabilitation, nursing, as well as psychological and social service categories of care that nursing facilities should provide to residents with MS. The health professionals identified mental health-related services as the most important care that nursing facilities should provide to residents with MS, followed by physical therapy, recreational therapy, occupational therapy, and neurological care.

Compliance with tuberculosis drug regimens: incentives and enablers offered by public health departments.

OBJECTIVES: This research examined incentives implemented by public health departments to encourage tuberculosis patients to comply with tuberculosis drug regimens. METHODS: A questionnaire addressing incentives was mailed to the directors of each state's health department during May 1995. All 50 states and the District of Columbia returned questionnaires. RESULTS: The survey results indicate that public health departments in almost all states are implementing the incentives advocated by tuberculosis experts. CONCLUSIONS: The implementation of these incentives may help to explain why the incidence of tuberculosis resumed its long-term decline in the United States during 1993 after a decade of resurgence.