Influence of providers and nurses on completion of non-targeted HIV screening in an urgent care setting.

INTRODUCTION: Despite recommendations by the Centers for Disease Control (CDC) that all adults be offered non-targeted HIV screening in all care settings, screening in acute-care settings remains unacceptably low. We performed an observational study to evaluate an HIV screening pilot in an academic-community partnership health center urgent care clinic. METHODS: We collected visit data via encounter forms and demographic and laboratory data from electronic medical records. A post-pilot survey of perceptions of HIV screening was administered to providers and nurses. Multivariable analysis was used to identify factors associated with completion of testing. RESULTS: Visit provider and triage nurse were highly associated with both acceptance of screening and completion of testing, as were younger age, male gender, and race/ethnicity. 23.5% of patients completed tests, although 36.0% requested screening; time constraints as well as risk perceptions by both the provider and patient were cited as limiting completion of screening. Post-pilot surveys showed mixed support for ongoing HIV screening in this setting by providers and little support by nurses. CONCLUSIONS: Visit provider and triage nurse were strongly associated with acceptance of testing, which may reflect variable opinions of HIV screening in this setting by clinical staff. Among patients accepting screening, visit provider remained strongly associated with completion of testing. Despite longstanding recommendations for non-targeted HIV screening, further changes to improve the testing and results process, as well as provider education and buy-in, are needed to improve screening rates.

A unique model of the community health worker: the MGH Chelsea Community Health Improvement team.

With current trends in legislation around the delivery of patient care, the role of a community health worker (CHW) is gaining growing and much deserved attention. However, a system needs to be built for any CHW program to be successful and sustainable. This article describes a unique approach to community health work at the Massachusetts General Hospital Chelsea HealthCare Center where a well-integrated CHW model provides support for everyone involved in patient care: patients, providers, the community at large, and the internal CHW staff.