A qualitative study of patient perspectives of care management services in Comprehensive Primary Care Plus.

BACKGROUND: Care management has the potential to improve quality of care and health outcomes for chronic conditions, but questions remain about how patients perceive care management. Understanding patient perceptions is critical for ensuring care management can successfully engage patients and improve management of chronic conditions. OBJECTIVE: To understand high-risk patients' experiences and perceptions of care management. METHODS: We conducted 1-h phone interviews with 40 patients receiving care management at 12 practices participating in the Centers for Medicare & Medicaid Services Comprehensive Primary Care Plus model. Interviews were transcribed verbatim and analysed using a thematic approach. RESULTS: Most patients reported discussing health goals with their providers that aligned with their values and care preferences; a few reported that goal setting did not result in desired action steps. Most reported positive experiences receiving behavioural health support; a few reported unmet behavioural health needs that they had not expressed to their practice. Patients reported financial and transportation barriers to following care managers' recommendations. Care managers' active listening skills, accessibility, and caring personalities facilitated patient engagement. CONCLUSIONS: Practices should consider patient perspectives as they improve care management activities. Future research is needed to confirm our findings about patient perspectives regarding goal setting, behavioural health support, and barriers and facilitators to engagement.

Care management, which involves providing additional support to people with chronic and mental health conditions, has the potential to improve the quality of health care people receive and to improve their overall health. Care management can involve doctors, nurses, and other staff at doctors' offices working with patients to set goals for their health and working with them to manage their physical and mental health. Despite the promise of care management to improve health, the way that patients think about and experience care management is not well known. In our study, we conducted interviews with 40 patients to understand their experiences and thoughts about care management. We found that most patients talk about health goals with their doctor or nurse, and that their health goals were consistent with their values and care preferences. Most patients reported positive experiences receiving support for mental health. Some patients explained that they had difficulty following through on appointments or other services recommended by their doctor or nurse because they could not afford the costs or because they did not have transportation. Nurses' caring personalities and availability outside of appointments helped patients to take actions to improve their health.

Beyond prevention of mother-to-child transmission: keeping HIV-exposed and HIV-positive children healthy and alive.

In 2011, Joint United Nations Programme on HIV/AIDS announced a plan to eliminate new HIV infections among children by 2015. This increased focus on the elimination of maternal to child transmission (MTCT) is most welcome but is insufficient, as access to prevention of MTCT (PMTCT) programming is neither uniform nor universal. A new and more expansive agenda must be articulated to ensure that those infants and children who will never feel the impact of the current elimination agenda are reached and linked to appropriate care and treatment. This agenda must addresses challenges around both reducing vertical transmission through PMTCT and ensuring access to appropriate HIV testing, care, and treatment for all affected children who were never able to access PMTCT programming. Option B+, or universal test and treat for HIV-infected pregnant women is an excellent start, but it may be time to rethink our current approaches to delivering PMTCT services. New strategies will reduce vertical transmission to less than 1% for those mother-infant pairs who can access them allowing for the contemplation of not just PMTCT, but actual elimination of MTCT. But expanded thinking is needed to ensure elimination of pediatric HIV.