The influence of healthcare financing on cardiovascular disease prevention in people living with HIV
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RESEARCH ARTICLE
Open Access
The influence of healthcare financing on cardiovascular disease prevention in people living with HIV Allison R. Webel1* , Julie Schexnayder1, C. Robin Rentrope1, Hayden B. Bosworth2, Corrilynn O. Hileman3,4, Nwora Lance Okeke2, Rajesh Vedanthan5 and Chris T. Longenecker3
Abstract Background: People living with HIV are diagnosed with age-related chronic health conditions, including cardiovascular disease, at higher than expected rates. Medical management of these chronic health conditions frequently occur in HIV specialty clinics by providers trained in general internal medicine, family medicine, or infectious disease. In recent years, changes in the healthcare financing for people living with HIV in the U.S. has been dynamic due to changes in the Affordable Care Act. There is little evidence examining how healthcare financing characteristics shape primary and secondary cardiovascular disease prevention among people living with HIV. Our objective was to examine the perspectives of people living with HIV and their healthcare providers on how healthcare financing influences cardiovascular disease prevention. Methods: As part of the EXTRA-CVD study, we conducted in-depth, semi-structured interviews with 51 people living with HIV and 34 multidisciplinary healthcare providers and at three U.S. HIV clinics in Ohio and North Carolina from October 2018 to March 2019. Thematic analysis using Template Analysis techniques was used to examine healthcare financing barriers and enablers of cardiovascular disease prevention in people living with HIV. Results: Three themes emerged across sites and disciplines (1): healthcare payers substantially shape preventative cardiovascular care in HIV clinics (2); physician compensation tied to relative value units disincentivizes cardiovascular disease prevention efforts by HIV providers; and (3) grant-based services enable tailored cardiovascular disease prevention, but sustainability is limited by sponsor priorities. Conclusions: With HIV now a chronic disease, there is a growing need for HIV-specific cardiovascular disease prevention; however, healthcare financing complicates effective delivery of this preventative care. It is important to understand the effects of evolving payer models on patient and healthcare provider behavior. Additional systematic investigation of these models will help HIV specialty clinics implement cardiovascular disease prevention within a dynamic reimbursement landscape. Trial registration: Clinical Trial Registration Number: NCT03643705. Keywords: HIV, Cardiovascular disease, Healthcare financing, Prevention, Relative value scales, Health planning support
* Correspondence: [email protected] 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and re
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