Service Utilization

SERVICE UTILIZATION FOR HEALTH CARE SERVICES

Case management and ambulatory/outpatient medical care were the most frequently utilized CARE Act services in 2004 (Table 12). CARE Act case management providers reported serving 367,074 HIV-positive clients in more than 4.2 million client visits in 2004. Case management services include activities such as initial assessment of service needs; development of a comprehensive, individualized service plan; coordination of client services; and periodic re-evaluation and adaptation of the individualized service plan over the life of the client.

CARE Act providers reported that ambulatory/outpatient medical care services were used by 361,131 clients in 2.3 million client visits in 2004. In addition to HIV primary care, this category of service utilization includes diagnostic testing, early intervention and risk assessment, preventive care and screening, practitioner examination, medical history taking, and other related activities.

Table 12. Number of Clients Served and Total Visit for Health Care and Case Management Services, 2004

*Does not include services by the Dental Reimbursement Program and the Community Based Dental Partnership Program. Source: Health Resources and Services Administration, HIV/AIDS Bureau, 2004 CARE Act Data Report.

Clients used three other health care service categories frequently in 2004. First, mental health services were used by 84,227 clients in 531,829 visits. Next, providers provided oral health care services to 76,376 clients in 230,046 visits. Finally, outpatient substance abuse treatment services were used by 36,070 clients in 551,844 visits. Outpatient substance abuse services are defined as medical treatment and counseling to address substance abuse problems provided in an outpatient setting rendered by or under the supervision of a physician.

NUMBER OF VISITS PER CLIENT BY SERVICE CATEGORY9

In 2004, the average number of visits for case management services was 13.9 for HIV-positive clients, down from 14.5 in 2003 and 6.3 for HIV-affected clients, down from 8 in 2003 (Table 13). For outpatient/ambulatory medical services, clients averaged 6.7 visits in 2004, down from 7 in 2002. Providers of outpatient substance abuse services reported an average number of 19.9 visits per client in 2004, down from 20.4 in 2002. Providers of mental health care services reported that on average, clients made 7.2 visits in 2004, down from 8 in 2002. Finally, for oral health care services, the average number of visits per client was 2.4 in 2004, down from 2.8 in 2002.

Table 13. Visits per Client by Type of Service, 2004

*The actual number of providers serving clients is higher. Data presented in the table are only for providers who reported complete data for
both number of clients and number of visits. Some providers offer multiple services and may be included in more than one service category.
**Does not include services by the Dental Reimbursement Program and the Community Based Dental Partnership Program.
Source: Health Resources and Services Administration, HIV/AIDS Bureau, 2004 CARE Act Data Report.

UTILIZATION OF SUPPORT SERVICES

CARE Act providers also deliver an array of supportive services to HIV-positive and HIV-affected clients to promote entry into and retention in HIV primary medical care (Table 14). CARE Act providers delivered the highest number of support services (duplicated client counts) in 2004 to HIV-positive clients in the following service categories: food bank/home-delivered meals (117,526), client advocacy (117,032), health education/risk education (129,070), transportation services (106,055), and treatment adherence counseling (124,000). Utilization of support services was somewhat different among HIV-affected clients. The highest number of support services (duplicated client counts) delivered to HIV-affected clients included outreach and health education/risk reduction - services designed to promote HIV counseling and testing and prevent further transmission of HIV among all CARE Act clients. For all categories of supportive services except outreach services, CARE Act providers reported serving larger numbers of HIV-positive than HIV-negative clients.

Table 14. Clients Who Received CARE Act Support Services by HIV Status: 2002, 2003, and 2004

Source: Health Resources and Services Administration, HIV/AIDS Bureau, 2002, 2003, and 2004 CARE Act Data Reports.

9 A client may only be counted for one visit for each service per day. For residential substance abuse treatment, each day in a residence facility counts as one visit.