4 Medical Director Interview Guide

Appendix D. Medical Director Interview Guide

OMB No. 0906-XXXX
Expiration date: XX/XX/201X

Providing Primary Care and Preventive Medical Services in Ryan White-funded Medical Care Settings:

Medical Director Interview Guide

Supported by the Health Resources and Services Administration, HIV/AIDS Bureau

Contract Number: HHSH250201400042I

Public Burden Statement:  An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  The OMB control number for this project is 0906- XXXX.  Public reporting burden for this collection of information is estimated to average .5 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-29, Rockville, Maryland, 20857.

Medical Director Interview Guide

Introduction

The Lead Interviewer introduces himself/herself, thanks the interviewee(s) for participating, and describes the purpose of the project and interview. The interviewee is then asked to describe his/her agency, position within the agency and job responsibilities.

The first set of questions has to do with how your clinic provides comprehensive and coordinated primary and preventative care to people living with HIV (PLWH).

1. Do your primary care providers provide primary care and preventative services to PLWH?

2. What proportion of the PLWH receive primary care and preventative services through the clinic?

3. Does your clinic have a protocol for providing primary and preventative care services, to PLWH?

   1. At what intervals do you perform physical exams for PLWH? What does a physical exam entail for PLWH?

   2. Are other diagnostic or lab tests performed at other times besides within their physical exams? When? Why?

   3. Do your clinicians monitor for relevant age, sex or gender specific primary health problems? What are they?

   4. What are some of the barriers in providing routine health maintenance services?

   5. What do you think needs to be done to improve your clinic’s routine health maintenance practices?

   6. Do your clinicians provide health promotion or prevention services, such as diet, nutrition and exercise, safer sex practices, or needed immunizations and screenings?

      1. What are some of the barriers in providing health promotion or prevention services?

      2. What do you think needs to be done to improve your clinic’s provision of health promotion or prevention services?

   7. Do your clinicians provide behavioral health counseling services such as screening for mental health issues or substance use?

      1. What are some of the barriers in providing behavioral health counseling?

      2. What do you think needs to be done to improve your clinic’s provision of behavioral health counseling?

4. What types of primary care providers do you have on staff to provide primary and preventative care services? How many are also HIV Specialists? Are they sufficient for the needs of your target population of PLWH? Why?

5. What services do you refer out? Why? In general, what factors are taken into account when selecting the physician that the patient is referred to?

6. If a clinician discovers that a patient has a comorbidity, do you have a protocol for providing, coordinating and following-up on their care? What are the challenges in following the protocol? What factors are taken into account to determine if the patient condition is managed by clinicians in the clinic or referred out?

Care Coordination of Primary and Preventative Care Services and HIV services

The second set of questions has to do with how your clinic coordinates primary and preventative care.

7. Describe how your clinic coordinates care for PLWH?

   1. Does each PLWH receiving primary and preventative care services have a main primary care clinician to oversee his/her treatment and care?

   2. If a PLWH has a comorbidity (ies), how is his/her care coordinated?

   3. Does each patient have a care team to coordinate their medical care? If yes, please describe care team functions and goals. If no, why?

   4. Does each patient have a case manager to coordinate other related non-medical care services? If yes, please describe case manager function and goals. If no, why?

   5. If PLWH also receive primary and preventative care services outside of the clinic, how are services coordinated with the primary care physician?

   6. What is the protocol or process to share patient information between the clinic and the referred agency? How/what information is shared and gathered?

   7. What are some of your clinic’s challenges to coordinating care for PLWH?

   8. What could be done to improve your care coordination with PLWH?

8. Do your primary care providers and other staff who treat PLWH consult with an HIV Specialist? When and how? If not, why?

9. If you refer a PLWH for services outside of the clinic, what is the protocol or process to share patient information between the clinic and the referred agency? How/what information is shared and gathered?

Influences on the Provision of Primary and Preventative Care

The last set of questions have to do with outside or organizational influences that support or may be an obstacle to your clinic in the provision of comprehensive and coordinated primary and preventative care services to PLWH.

10. Are there any federal or national level or state or local mandates (guidelines/standards) or programs that influence or affect how your clinic provides primary and preventative care to PLWH? Do they limit your provision of primary and preventative care services? How? Do they positively or negatively affect your provision of primary and preventative care in any way?

11. How does a patient’s insurance, private and public, influence the primary and preventative care services that PLWH receive? What resources do you use to provide necessary services that a PLWH needs?

12. What are some of your clinic’s other challenges in providing primary and preventative care services to PLWH?

13. What are some of your clinic’s strengths in providing primary and preventative care services to PLWH?

14. Do you have an advisory/ governing body that influences your provision of primary and preventative care services to PLWH? If applicable, can you describe this advisory/governing body and any examples of how it influenced your model for primary and preventative care services to PLWH?

    1. If you have an advisory/ governing body that influences your provision of primary and preventative care services, do they review or evaluate how the clinic is providing these services?

    2. How does it review or evaluate and how often?