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PubMed1988

Evaluation of comprehensive program for diabetes care at primary health-care level.

The Swedish National Board of Health and Welfare published its first diabetes health-care program in 1977. The impact of the program was evaluated in the Stockholm County after 4 yr. The results showed that the educational program had reached greater than or equal to 1 staff member in 86% of the 104 primary health-care centers (PHCCs). Several organizational changes had taken place as a result of the program. The 10 "best" PHCCs were compared with a random sample of the centers with regard to patient outcomes. Patients from the 10 best centers had gotten a more comprehensive education, were more knowledgeable about foot care, tested glucose more often, and used less medication. The metabolic control was the same for both groups of patients. The PHCC staffs reported the following roadblocks to change: lack of knowledge of diabetes care, insufficient cooperation between staff members, poor contact with specialists, and absence of guidelines for diabetes care. The staffs in the best centers spent twice as much time in staff meetings and continuing education as those from the random sample of centers. The findings led us to formulate a new strategy for the program. The main objective of the new approach is to create organizational changes within the centers. Thus, local knowledge and creativity can be utilized. Preliminary data demonstrate that 84% of the locally developed plans for reorganization of diabetes care had been accomplished within 1 yr.

Diabetes Mellitus↗
PubMed1996

Surgery in South Africa.

The practice of surgery in South Africa ranges from full-time service in state-funded and academic hospitals serving a largely indigent population to a private sector for medically insured patients. Surgical training occurs at eight medical schools, and specialist registration is obtained after 4 to 5 years with either a university-conferred degree or a fellowship from the College of Surgeons of South Africa. The wide spectrum of First- to Third-World diseases and the high incidence of trauma provide comprehensive experience for practical training. Surgical standards are uniformly high, matching and sometimes pioneering the very best of Western medicine. The health care system is undergoing radical change to correct the imbalances of the apartheid era. Academic institutions are under pressure, and with incipient major financial cutbacks, there is concern that the proud record of service, teaching, and research excellence may be compromised. To facilitate the mission of broadening health care services, diploma training in surgery for rural practitioners is being developed. Outreach programs and closer liaisons with surgical societies in sub-Saharan African countries have also been initiated.

Academic Medical Centers↗
PubMedDate not supplied

Training for primary care of mentally handicapped patients in US family practice residencies.

BACKGROUND: As a result of managed care mandates for primary care and the growing community presence of the 6 million mentally handicapped persons in the United States, primary care of this population will increasingly be provided by family physicians. How much family practice residencies emphasize training for care of this population is the focus of this study. METHODS: A questionnaire was mailed to each family practice residency program in the United States asking about didactic teaching, clinical activities, and faculty and curriculum planning related to care of the mentally handicapped population. RESULTS: Seventy-one percent of questionnaires were returned. Only 32 percent of respondents teach related didactic sessions, 24 percent plan clinic patient care for this population, and 42 percent affiliate with a residential care facility. The most frequently listed didactic topics were delayed infant assessment and seizure care. Comprehensive management of the mentally handicapped adult, family issues, behavioral problems, and long-term planning had low ratings compared with the first two topics. Psychiatrists were rated higher than family practice faculty for training in this area. CONCLUSIONS: There is little enthusiasm among residency directors about the need for training in care of mentally handicapped patients. Topics that are most valued, however, were those that are generally within the purview of specialists. A low value was placed upon training for helping families access services, behavior management, or comprehensive long-term planning-areas most often addressed by family physicians. Further studies are needed to assess the training needs of family physicians in caring for mentally handicapped persons.

Adult↗
PubMed2002

Outreach and improved access to specialist services for indigenous people in remote Australia: the requirements for sustainability.

STUDY OBJECTIVE: To examine the role of specialist outreach in supporting primary health care and overcoming the barriers to health care faced by the indigenous population in remote areas of Australia, and to examine issues affecting its sustainability. DESIGN: A process evaluation of a specialist outreach service, using health service utilisation data and interviews with health professionals and patients. SETTING: The Top End of Australia's Northern Territory, where Darwin is the capital city and the major base for hospital and specialist services. In the rural and remote areas outside Darwin there are many small, predominantly indigenous communities, which are greatly disadvantaged by a severe burden of disease and limited access to medical care. PARTICIPANTS: Seventeen remote health practitioners, five specialists undertaking outreach, five regional health administrators, and three patients from remote communities. MAIN RESULTS: The barriers faced by many remote indigenous people in accessing specialist and hospital care are substantial. Outreach delivery of specialist services has overcome some of the barriers relating to distance, communication, and cultural inappropriateness of services and has enabled an over fourfold increase in the number of consultations with people from remote communities. Key issues affecting sustainability include: an adequate specialist base; an unmet demand from primary care; integration with, accountability to and capacity building for a multidisciplinary framework centred in primary care; good communication; visits that are regular and predictable; funding and coordination that recognises responsibilities to both hospitals and the primary care sector; and regular evaluation. CONCLUSIONS: In a setting where there is a disadvantaged population with inadequate access to medical care, specialist outreach from a regional centre can provide a more equitable means of service delivery than hospital based services alone. A sustainable outreach service that is organised appropriately, responsive to local community needs, and has an adequate regional specialist base can effectively integrate with and support primary health care processes. Poorly planned and conducted outreach, however, can draw resources away and detract from primary health care.

Community-Institutional Relations↗
PubMed2001

Linking nursing pain assessment, decision-making and documentation.

A clinical nurse specialist's (CNS) experience in the development and implementation of a pain assessment and treatment flowsheet (PATF) to enhance the nursing assessment, decision-making, and documentation of pain on a palliative care unit in a community hospital is described in this article. Members of the palliative care interdisciplinary team use the PATF for clinical decision-making in the day-to-day management of patients' pain. The PATF is undergoing revision and re-implementation to promote the utilization of the tool beyond the specialty of palliative care and into the general patient population.

Decision Making↗
PubMed1996

An intervention program to reduce the hospitalization cost of asthmatic patients requiring intubation.

BACKGROUND: Asthma is the single disease that accounts for the largest proportion of total health care cost in the US. OBJECTIVE: To analyze whether an asthma management program affected the cost of subsequent asthma care for patients in whom intubation had been necessary. METHODS: We evaluated patients with asthma who (1) had required intubation for treatment of status asthmaticus; (2) were 45 years old or younger; (3) had regular follow-up visits in our clinic for 1 year after initial evaluation; and (4) had complete medical records 1 year before and 1 year after the intervention for our evaluation. Medical costs of asthma treatment for each patient were determined for 1 year before and 1 year after intervention. The program included patient education, regular outpatient visits, specialist care, and access to the Allergy Immunology emergency call service. The outcome measures were the total cost of care, inpatient hospitalizations, outpatient services, emergency services, and medicine costs. RESULTS: Nine patients [mean age 19.6 years (SD = 9.9)] fulfilled the criteria (six women and three men). The mean duration of asthma was 14.0 years (SD = 9.7). The mean total cost of care decreased from $43,066 to $4,914 (t = -4.53, P < .001) and inpatient hospitalization costs decreased from $40,253 to $1,926 (t = -4.50, P <.001). There was, however, no significant difference in the mean pre-intervention versus post-intervention cost of emergency services, outpatient services, or medicine costs. CONCLUSIONS: The intervention--which included education, specialist care, regular outpatient visits, and access to an emergency call service--significantly reduced the cost of asthma care in our population of patients intubated for asthma.

Adolescent↗
PubMedDate not supplied

A collaborative community-based oral care program for school-age children.

PURPOSE/OBJECTIVES: In Vermont in 2001, less than half of school-age children on Medicaid received dental services. Vermont is a designated resettlement area for refugees, many of whom have never had dental care. A school-based oral health program was designed to meet the needs of this high-risk pediatric population. PROGRAM: A plan was developed to offer dental services to this group of children. Through the efforts of a multidisciplinary committee the Tooth Tutor Program, developed by the Vermont Department of Health, dental care was made available to the children. The Tooth Tutor Program provides cost-effective dental hygienist care to children in the school setting and includes referral to community dentists. OUTCOME: The program was able to provide services to approximately 500 children in the first 2 years with an increase in preventative services and decrease in restorative services from year 1 to year 2. After 3 years, a school-based dental service opened in 1 of the 3 target schools. CONCLUSION: A school-based dental service that includes education, screening, and referral can be an effective program for improving oral health among impoverished children. IMPLICATIONS FOR NURSING PRACTICE: For the community health clinical nurse specialist, the client is the community. Clinical nurse specialist practice in this community resulted in improved oral health for high-risk school-age children. This program can be adapted for other communities.

Child↗
PubMed1989

Health care provision and access opportunity in Madras city.

This short paper has reported on the health care provision and access opportunity in Madras city, India, using three city areas as sample areas. Maps have indicated that a general concentration of both GP and specialist practices, although access opportunities in the peripheries do not point up to paucity of services. The study is a report on private practices that is an important element in the health services provision.

Delivery of Health Care↗
PubMedDate not supplied

Long-term oxygen therapy in Ioannina.

BACKGROUND: Long-term oxygen treatment (LTOT) is very important, especially in patients with severe chronic obstructive pulmonary disease (COPD), but its efficacy is closely related to patient compliance. OBJECTIVES: The aim of the present study was to investigate the compliance of patients under LTOT in the Prefecture of Ioannina (north-western Greece) and to identify factors that might be involved. METHODS: The study included 249 patients treated with LTOT during a 1-year period. They were visited at home by the investigating staff (a chest specialist and a primary care nurse). Compliance to therapy was defined by the daily use of the O2 concentrator (in hours). Patients underwent pulse oximetry, basic spirometry, and trial inhalation of bronchodilators. RESULTS: Only 67 patients (26.9%) complied with therapy, while the daily concentrator use lasted 9.7 +/- 6.09 h. SaO2, FEV1 and FVC were negatively correlated to patient compliance. No significant differences concerning LTOT compliance were noted between men and women, urban and rural population, and between smokers, ex-smokers and non-smokers. A chest physician recommended LTOT for the majority of patients (86.3%), while COPD was the main reason for LTOT prescription (74.7%). Nevertheless, compliance to LTOT was not significantly higher when prescribed by a respiratory physician. No specific medical instructions and information was recorded for the majority of the study patients treated with LTOT. CONCLUSIONS: Our results suggest that an organized home care program establishing the relative guidelines is necessary for substantial improvement in patient compliance to LTOT in Greece.

Aged↗
PubMed1996

Magnitude and management of HCV infection in France.

The prevalence of hepatitis C virus infection in the general population in France averages 1%. The majority of these patients are viremic with detectable HCV-RNA. Further, 75% of these individuals did not suspect they were at risk for being HCV carriers. Less than 10% of HCV carriers in France have been identified and even fewer have been treated with interferon. In addition to infection following intravenous drug use, preliminary studies suggest that most newly infected patients have become infected following surgery or endoscopy without transfusion. A large serological study of patients scheduled for surgery identified 4% HCV carriers. Other studies have determined that more than 8% of patients who received prior transfusions are now anti-HCV positive. These findings prompted the French government to initiate a screening program in France to identify patients at risk for HCV infection. This national program also involves the establishment of regional HCV reference centers to coordinate efforts among hospitals, gastroenterology/hepatology specialists, and general practitioners. The mission of the program is to promote screening and disseminate appropriate clinical practice guidelines for the management of HCV infection. The goal is to identify infected patients and initiate optimal interferon therapy as early as possible in the course of HCV infection to prevent the long-term complications secondary to infection.

Carrier State↗
PubMed1999

[Assessment of mammography screening and its introduction in Germany in the Statutory Early Diagnosis Program].

Malmö, in the south of Sweden, has, over the past 15 years, achieved a reduction in the mortality rate of 10% as a result of adjuvant drug treatment (adjuvant chemo- and hormone therapy). The drop in the mortality rate by means of a quality assured early diagnosis programme, reduces the mortality rate for breast cancer by 34% so that in South Sweden these methods have reduced the death rate for breast cancer by a total of 44% although the incident rate has increased by 1.25%. It follows that a quality assured early diagnosis programme is by far the most effective method of reducing the mortality rate for breast cancer, whereby breast cancer constitutes the main cause of death from cancer in women. The effectiveness of early diagnosis is dependent on experience with these methods whereby the learning curve, even in the case of specialists, does not reach a maximum until there has been at least 6-8 years experience and a minimum of 8000 patients have been seen. A reduction in the mortality rate can only be achieved if a large number of the population takes part (in Sweden, 89% of women contacted) and only applies to the age group 40-70. In the case of younger women (40-50 years) the reduction in the death rate in Sweden lies at 30%. For cost-benefit reasons this age group has not yet been recommended for routine screening in Sweden, apart from in clinical studies. Screening is only effective with complete quality control of technical equipment and personnel as stipulated in the European guidelines for screening mammography (August 1997 edition, EU Commission (EUREF). The risks of radiation exposure, with a threshold value of 5 mGy per breast (X-ray in two planes), is so minimal that it is as yet not measurable. The induction of breast cancer through annual screening mammography is estimated theoretically at 4 indicated cases of breast cancer to 1 million female years. Theoretically these induced cases of breast cancer can be cured by early diagnosis. A reduction in the mortality rate of 34% is a tremendous advantage for women. Since breast cancer is the main cause of death in women between the ages of 38 and 51 and screening considerably cheaper than other preventive measures (cervical smear, dialysis in kidney disease, safety belts, medication to lower cholesterol levels) the introduction of quality assured screening is an essential priority towards improving the health of women in society today. It has been proved (Netherlands) that the cost of screening is far lower than the expense incurred in the treatment of women in the metastatic stage of their cancer illness before death.

Adult↗
PubMed2005

Quality and access to care among a cohort of inner-city adults with asthma: who gets guideline concordant care?

STUDY OBJECTIVES: Asthma morbidity is highest among inner-city populations. This study measured whether quality and access to care over time was concordant with National Asthma Education and Prevention Program (NAEPP) guidelines. It also identified factors associated with NAEPP guideline-concordant care. DESIGN: A prospective, observational cohort study. SETTING: An urban academic medical center. PATIENTS: A consecutive cohort of 198 inner-city adults hospitalized for asthma. MEASUREMENTS: Detailed information about sociodemographics, asthma history, access to care, history of the current exacerbation, prescription and use of inhaled corticosteroids (ICS) and beta-agonists, and other elements of NAEPP-concordant care (spacers, metered-dose inhaler [MDI] technique, peak flow meters, and action plans) was collected during the index admission and 1 month and 6 months after discharge. RESULTS: In this predominantly low-income, nonwhite cohort, while 92% of patients had insurance and 80% had a usual source of care, 73% reported delays in seeking care. ICS were prescribed for 77% of patients prior to hospital admission, 83% at 1 month, and 67% at 6 months. Adherence with other NAEPP recommendations were 89% for receipt of MDI instruction, 68% for spacers, 80% for peak flow meters, 31% for written action plans for worsening, and 22% for written plans for attacks. In multivariate analysis, greater asthma severity and having a usual source of care increased the odds of receiving ICS, spacers, and peak flow meters. Care by a specialist increased the odds of receiving action plans. Patients who spoke mostly Spanish were less likely to be given spacers or action plans. CONCLUSION: Baseline problems with quality and access to care persisted over time. Better systems of care are needed to ensure that high-risk patients receive an appropriate step-up in the quality of ongoing asthma care.

Adult↗
PubMed2000

Health technology assessment in the United Kingdom.

The National Health Service (NHS) provides universal health coverage for all British citizens. Most services are free of charge, although modest copayments are sometimes applied. About 11% of the population also has private insurance. General practitioners, generally the first point of contact for accessing the system, are independent contractors who serve as gatekeepers for specialist and hospital services and enjoy substantial clinical autonomy. Hospitals are public and are regionalized, but the 1990 reforms made them self-governing trusts that contract with local purchasers (health authorities and general practitioner fundholders). Reforms beginning in 1990 moved the NHS away from a centralized administrative structure to more pluralistic arrangements in which competition, as well as management, influences how services develop. Health technology and health technology assessment (HTA) have gained increasing attention in the NHS during this period, as part of a wider NHS Research and Development (R&D) Strategy. The strategy promotes a knowledge-based health service with a strong research infrastructure and the capacity to critically review its own needs. HTA is the largest and most developed of the programs within the strategy. It has a formal system for setting assessment priorities involving widespread consultation within the NHS, and a National Co-ordinating Centre for Health Technology Assessment. The strategy supports related centers such as the U.K. Cochrane Centre and the NHS Centre for Reviews and Dissemination. A hallmark of the HTA program is strong public participation. The United Kingdom has made a major commitment to HTA and to seeking effective means of reviewing and disseminating evidence.

Delivery of Health Care↗
PubMed2004

Cost-effectiveness of digital photographic screening for retinopathy of prematurity in the United Kingdom.

OBJECTIVES: To compare the cost-effectiveness of alternative methods of screening for retinopathy of prematurity (ROP) in the United Kingdom, including the existing method of indirect ophthalmoscopy by ophthalmologists and digital photographic screening by nurses. METHODS: A decision tree model was used to compare five screening modalities for the UK population of preterm babies, using a health service perspective. Data were taken from published sources, observation at a neonatal intensive care unit (NICU), and expert judgment. RESULTS: We estimated that use of standard digital cameras by nurses in NICUs would cost more than current methods (pound 371 compared with pound 321 per baby screened). However, a specialist nurse visiting units with a portable camera would be cheaper (pound 172 per baby). These estimates rely on nurses capturing and interpreting the images, with suitable training and supervision. Alternatively, nurses could capture the images then transmit them to a central unit for interpretation by ophthalmologists, although we estimate that this would be rather more expensive (pound 390 and pound 201, respectively, for NICU and visiting nurses). Sensitivity analysis was used to examine the robustness of estimates. CONCLUSIONS: It is likely that there is an opportunity to improve the efficiency of the ROP screening program. We estimate that screening by specialist nurses trained in image capture and interpretation using portable digital cameras is a cost-effective alternative to the current program of direct visualization by ophthalmologists. This option would require the development of a suitable portable machine. Direct comparative research is strongly needed to establish the accuracy of the various screening options.

Cohort Studies↗
PubMed1997

The World Health Organization Network for Radiation Emergency Medical Preparedness and Assistance (REMPAN).

The World Health Organization (WHO) has established a system of collaborating centers known as the Radiation Emergency Medical Preparedness and Assistance Network (REMPAN) to promote radiation emergency medical preparedness, assistance, and advice to countries in cases of overexposure of populations from any source of radiation. This network consists of 13 specialized institutions located in 10 countries. Within the REMPAN there are three separate but linked activities. The first is aimed at strengthening radiation emergency medical preparedness and assistance to treat and monitor acutely exposed individuals. The second activity is directed toward improving public health advice to mitigate long-term effects of exposure to low and protracted doses that might accrue in populations living in the affected territories. This involves giving advice on protecting public health, e.g., iodine prophylaxis, psychosocial risks associated with countermeasures, and public information strategies. In addition, the REMPAN develops activities aimed at improving long-term follow-up studies and preparedness for epidemiologic investigations in territories contaminated by radionuclides from a nuclear accident. The WHO's response in a radiation emergency depends on the type of accident and its time phase. This includes a wide range of actions from studying the situation to providing medical and public health assistance through the network of collaborating centers and relevant institutions within the REMPAN. The process of creating a reliable international system for radiation emergency medical preparedness and assistance has not yet been completed. Deficiencies in this system are outlined in this paper to attract the attention of specialists in the field of radiation protection and potential donors of the WHO program.

Disaster Planning↗
PubMedDate not supplied

[Validation of the QFS measuring the frequency and satisfaction in social behaviours in psychiatric adult population].

INTRODUCTION: Although everyone working in routine mental health services recognizes the scientific and ethical importance to ensure that treatments being provided are of highest quality, there is a clear lack of consensus regarding what outcome domains to include, what measure of assessment to use and, moreover, who to question when assessing. LITERATURE FINDINGS: Since the fifties, social functioning is considered as an important dimension to take into account for treatment planning and outcome measuring. But for many years, symptoms scales have been considered as sufficient outcome measures and social functioning improvement expected on the basis of symptoms alleviation. As symptoms and social adjustment sometimes appear relatively independent, no accurate conclusion concerning the patient's social functioning can so be driven on the basis of his clinical symptoms. More attention has then been directed toward the development of instruments specifically intended to measure the extent and nature of social functioning impairments observed in most psychiatric syndromes. Many of these instruments are designed to be completed by caregivers or remain time consuming and difficult to use routinely. Presently, in clinical practice, there is a need to rely on simple and brief instruments considering patients'perspective about their social adjustment as a function of time. AIM OF THE STUDY: The aim of this study is to present a new instrument, the QFS, initially developed in order to assess social functioning in patients involved in group psychotherapy programs conducted in a specialist mental health setting, as well as its psychometric characteristics. METHODOLOGY: It was designed to be completed in less than 10 minutes and the questions are phrased in a simple and redundant way, in order to limit problems inherent to illiteracy or language comprehension. The QFS is a 16 items self-report instrument that assesses both the frequency of (8 items) and the satisfaction with (8 items) various social behaviours adopted during the 2 weeks period preceding the assessment. It yields three separate indexes of social functioning, defined a priori and labelled "frequency", "satisfaction" and "global". The higher the scores, the better the social functioning. The QFS was administered to 457 subjects, aged between 18 and 65, including 176 outpatients (99 with anxious or depressive disorders, 25 with personality disorders and 52 with psychotic disorders) and 281 healthy control subjects. RESULTS: No significant difference was found between patients and controls according to age or gender distribution. Acceptance rate was high (>95%). Moreover, the QFS was generally acceptable to the clinicians who used it. Internal consistency calculated for each index ranged from 0.65 to 0.83 (Cronbach alpha). Test-retest reliability, calculated within a 15 days time interval on a sample of 49 healthy controls, ranged from 0.69 to 0.71 (intraclass correlation coefficient). Discriminant validity was calculated on healthy controls and patients divided into sub-groups according to their diagnosis. It showed to be excellent, with significantly higher scores in control subjects than in psychiatric patients and significant differences across diagnostic categories (Kruskal-Wallis ANOVA with post-hoc tests, all p<0.05). The convergent validity of the QFS with other measures of social functioning was calculated, using the Social Adaptation Self-Evaluation Scale (SASS) and the Social Adjustment Scale Self-Report (SAS-SR). With the SASS, the convergent validity was higher among patients (Spearman rS 0.71 to 0.92, p<0.01) than controls (rS from 0.49 to 0.66, p<0.001). In healthy controls, correlation with the SAS-SR was moderate but statistically significant (rS from - 0.21 to - 0.44, p<0.05). When comparing QFS scores with self-rated symptoms severity, lower levels of social functioning were significantly associated with more severe symptoms according to the Brief Symptom Inventory (BSI: rS from - 0.38 to - 0.65, p<0.001). The QFS indexes demonstrated sensitivity to change (Wilcoxon: all p<0.05) on a sample of 27 out-patients suffering from anxious-depressive disorders questioned before and after 4 months of cognitive behavioural group therapy running on a weekly basis during 16 sessions of 2 hours each.The factorial validity of the QFS was measured through 3 separate factor analysis conducted using the data of 457 subjects. The first analysis considered only Frequency items; 7 out of 8 items had loadings above 0.5 on Factor 1 accounting for 30.7% (unrotaded) of the variance. The second analysis considered only Satisfaction items; all items had loadings above 0.6 on Factor 1 explaining 43.4% (unrotaded) of the variance. And finally, in the third factor analysis, all QFS items were included; 15 out of 16 items had loadings above 0.4 on Factor 1 accounting for 30% (unrotated) of the variance. Concerning the factorial validity of the instrument, these results suggest that all QFS items belong to the same underlying dimension. DISCUSSION: Finally, provisional norms for the QFS are provided for healthy controls, in order to characterise individual patients or patient subgroups. In conclusion, the need for assessment in clinical routine, in order to estimate different aspects of patients conditions as well as the quality of the treatment provided, has contributed to the development of a large variety of instruments measuring several domains. Concerning the level of social functioning, many instruments fail to meet chief criterion of feasibility, remaining often too complex or time onsuming. Moreover, only few of them are available in French. CONCLUSION: The QFS presented here is a brief, simple and easy to administer self-rating scale that displays satisfactory psychometric properties. It seems to be a valuable instrument for the monitoring of social functioning in psychiatric patients which, from a therapeutic point of view, may have a clear impact as it sets up expectation of change and allows both to reality test patients and therapists beliefs about the presence of progress or not and to identify if therapy is working on this specific outcome domain. Though, to date, the administration of the QFS to other populations and treatment modalities requires further investigation.

Adolescent↗
PubMed1998

The University of Minnesota Youth and AIDS Projects' Adolescent Early Intervention Program: a model to link HIV-seropositive youth with care.

The survival of human immunodeficiency virus (HIV)-positive adolescents may be abbreviated by delays in health care delivery. Methods of linking youth with services have not been well studied. With support from the Special Projects of National Significance Program, the Youth and Acquired Immunodeficiency Syndrome (AIDS) Projects' (YAP) Adolescent Early Intervention Program offers early intervention health care services to all affected youth in Minnesota, a state with mandatory reporting of HIV/AIDS cases. The conceptual framework is a novel application of traditional public health disease surveillance strategies to link HIV-positive adolescents with health care services. The target population is composed of all 13-22-year-old HIV-positive persons reported to the Minnesota Department of Health (MDH). MDH staff locate and contact HIV-positive youth, conduct structured interviews regarding health status and needs, and facilitate enrollment at YAP. Sixteen male and 20 female participants (mean age 21 years; 56% people of color; 32% gay or bisexual) reported serious health risks, including inconsistent condom use (83%), poverty (78%), high school dropout (56%), unemployment (50%), illegal conduct (50%), medical debt (42%), unstable living situations (33%), running away (33%), substance abuse (33%) and attempted suicide (28%). More than one third reported each of six HIV-related symptoms. Seventy-five percent of participants sought advocacy/case coordination; 56%, clinical trials of experimental therapies; and 50%, vocational training and access to entitlement/eligibility programs. Linking HIV-positive youth to care is a valuable extension of the work of disease intervention specialists in states with similar reporting systems.

Acquired Immunodeficiency Syndrome↗