Service Utilization

Using data from Section 3 of the CADR, this section of the report describes provider services utilized by clients through the CARE Act between January 2002 and December 2002. The service utlization narrative is based on the data tables presented in this section.

SERVICE UTILIZATION FOR HEALTH CARE SERVICES

Organizations providing one or more health care and/or case management service report the number of clients receiving each service as well as the total number of visits per service. Table 10 presents the total number duplicated clients served and the number of visits reported by CARE Act providers during 2002 for each health care service and case management. Case management services and outpatient/ambulatory medical care services were the most frequently utilized CARE Act services in 2002. CARE Act case management providers reported serving 332,377 HIV-positive clients. More than 3.6 million client visits were recorded by the CARE Act providers delivering case management services to HIV-positive clients. 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.

Table 10. Health Care and Case Management Services, Ryan White CARE Act, 2002

Next, CARE Act providers reported that outpatient/ambulatory medical care services were used by 319,295 clients in a little more than 2 million client visits. 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. Clients frequently used three other health care service categories. First, outpatient substance abuse services are defined as the medical treatment and counseling to address substance abuse problems provided in an outpatient setting rendered by a physician or under the supervision of a physician. Slightly more than 36,000 clients received outpatient substance abuse treatment services from providers in 2002. This service category reported 630,175 client visits during the reporting period. Second, mental health services were utilized by 81,437 clients in 609,314 visits. Finally, a total of 71,504 clients received oral health care services (excluding services funded by the Dental Reimbursement Program and the Community Based Dental Partnership Program) in 2002. Providers of oral health care reported 219,045 client visits. Service utilization for other health care services in 2002 is presented in Table 10.

NUMBER OF VISITS PER CLIENT BY SERVICE CATEGORY

The average number of visits per client by type of service is presented in Table 11. It is important to note that for each service type, the actual number of providers serving clients is higher. However, the average number of visits per client was calculated only for those providers reporting valid data for both the number of clients served and number of visits. Please note that providers may offer multiple services; thus, a provider may be included in more than one service category. In addition, the median number of visits per clients is presented for health care service visits per client.

Table 11. Number of Visits per Client by Service Category, 2002 [footnote 17, 18, 19, 20]

*Data reported in this table are based on valid reports only.  Valid data are defined as providers reporting complete data for
  both number of clients served and number of visits.

Of the outpatient substance abuse services utilized in 2002, the average number of visits per clients was 20.42 (median=6.13; range=1 - 321.52). For mental health care services utilized, the average number of visits per clients was 7.97 (median=5.12; range=1 - 96.77). Finally, for oral health care services (not including services funded by the Dental Reimbursement Program and the Community Based Dental Partnership Program), the average number of visits per clients was 2.79 (median=2.20; range=1 - 67.83).

UTILIZATION OF SUPPORT SERVICES

CARE Act providers also deliver an array of supportive services to HIV-positive and HIV-affected clients (Table 12, page 16). Supportive services are offered by CARE Act programs to promote entry into and retention in HIV primary medical care. CARE Act providers delivered the highest number of support services (duplicated client counts) to HIV-positive clients in the following categories of service: food bank/home-delivered meals (113,673 clients), client advocacy (113,363 clients), health education/risk reduction (111,716 clients), transportation services (100,185 clients), and treatment adherence counseling (91,948 clients). Utilization of support services was somewhat different among HIV-affected clients. The highest number of support services (duplicated client counts) delivered by CARE Act providers to HIV-affected clients included outreach services (86,116 clients) and health education/risk reduction (76,045 clients). Outreach and health education/risk reduction services endeavor to prevent further transmission of HIV among CARE Act clients who are HIV-positive, HIV-affected, and those for whom HIV/AIDS status is unknown. Notice that for all categories of supportive services, CARE Act providers reported serving larger numbers of HIV-positive clients than HIV negative clients.

Table 12. Number of Duplicate Clients Receiving Support Services From the CARE Act, 2002