1. Improving Retention Workshop Breakout Notes 2/18/2010

2. Barriers Brainstorm Lack of communication with providers Charts go off site before known with providers Lack of understanding of importance Level of complacency Change of pt. population/lack of staff understanding of pt. barriers Homelessness Substance abuse Special populations (e.g. prison release) Retention rate vs. no show rate Co-morbidities/other chronic care issues Psychological burnout for pts. Travel/transportation/public transportation Current contact info, esp for unstable housing, relocated or those who may have not disclosed status to others and don’t provide accurate info

3. Need for same-day care after testing positive Pt. who work have difficulties getting time off for appts Need for weekend and evening hours “AIDS” in name of clinic Denial of disease status Staff retention/turn-over Support systems (parents, generational belief systems Cultural beliefs around healthcare Wait of appoints/length of time between Health literacy Lack of comfort with provider (e.g. male gyn, etc) Staff who don’t speak same language Childcare needs Barriers Brainstorm

4. Solutions 1.Addressing pts with mental health issues Offer HIV testing at inpatient and out patient psyche facilities Increase $ for onsite mental health services Increase access to mental health, acceptance of ADAP/Medicare

5. Solutions 2. Lack of pt. understanding of importance of visit/denial Improving orientation for new patients (monthly welcome breakfast, offer peer services from beginning, best way to communicate with pt from beginning) Using existing support groups/consumers to get input/feedback on ideas Teach staff to use health literacy techniques and tools Obtain baseline assessment of pt. healthcare values Improve staff communication skills Staff and pt. collaboration to develop care plan Address pt’s other priority needs first (food, housing, etc)- one-stop shop for services Address coordination and communication of staff so all are aware of pt. needs

6. Solutions 3. Wait time Acknowledge that patients’ time is important- keep them updated on wait times How to effectively manage walk-ins to not impact scheduled appts. (e.g. algorithm for walk-ins) Schedule other activities while waiting to see clinician to use time effectively (see CM, nutritionists, etc)

7. Solutions 4. Current Contacts Refer to free phone and minutes from state If moved, refer to local services Ensure contact info is up-to-date at each visit Be proactive- ensure patients are enrolled in SNPS Ability to contact other stakeholders/providers regarding pt follow up/current care Ability to contact insurance carriers and other outside agencies (i.e. COBRA) to follow up on pts.

8. Solutions 5. Health Literacy Use patient-centered approach to identify how pt best learns- offer an range of methods for pts to choose from Develop presentations/formats that appropriate to pt. needs Continued training for staff around health literacy