Introduction-

(Thank them) We are going to ask you about several different topics as they relate to how your clients access your health care services. If any of your answers to these questions are different for HIV and STDs, please specify and answer each. I would like to emphasize that these interviews are confidential and your name will not be attached to the answers you give when we report this data. Do you have any questions before we get started?

Confidentiality and Security of Records

HD interviewee_____________

Project members _____________

Date of interview_____________

Time began _______________

We'd like to ask you about your methods of ensuring patient confidentiality and security of records.

How does the department assure that communication with patients is confidential? (letters, phone, visits, etc.)
How does the department keep patient records, databases, and lab test results secure?
While a patient is accessing care at your department, what steps are taken to make them aware of confidentiality policies?
Have you had many questions from patients pertaining to changes in confidential vs. anonymous testing? Y/N 4a)If so, what do you tell them? (For example, changes in HIV reporting laws such as the push toward confidential testing and discussion of unique identifiers.)
What type of training does your staff have concerning confidentiality?
Is there a need for further training regarding confidentiality?

Public Education

The next few questions concern ways you educate the public about the risks of HIV/STDs and about the services that are available to them.

What strategy does the public health department use to reach the community and to make them aware of the services they provide? (If they give more than one, ask which one they feel is the most effective).
What strategy does the public health department use to reach the community and to make them aware of HIV and STD issues/risk factors?
Do you target specific populations in your attempts at public education?
1. Y/N
2. 3a)What are these populations, and why do you specifically target them?
3. 3b)What strategies do you use to reach these populations?
How do changes in the HIV/STD epidemics change the way you educate the public? (past, present, or future)
What sort of training is available for health educators, or for staff whose duties also include public education?
Do you feel that additional training is needed?

Clinic accessibility

The following questions are about ways your health district makes sure clients can access your services in ways that are convenient to them.

What are your hours of operation?
Do you monitor hours of operation to ensure that any changes made are adequate for patients? Y/N....... 2a) If so, how?
Do you have a list of all the clinics in the district? Y/N (if yes, get copy)
Do you believe there is a need for additional health clinics in your district? Y/N......... 4a) If so, where?
Do you help provide transportation for your clients, either through reimbursement, contracted taxi service, a van, or other means?
1. (Examples) Y/N
Do you feel that the aesthetics of your department influence whether or not patients feel comfortable coming to the clinic? Y/N
Do you feel that safety concerns influence whether or not patients feel comfortable coming to the clinic? Y/N

Specific At-risk Populations

Next we'd like to ask you about specific populations that may be of particular concern to your health department. The literature shows that these groups tend to be at high risk for HIV and STD transmission, and we are interested in knowing if these populations are predominant in your district and how you reach or provide services to this population.

Immigrant Y/N (If so)........ How is population reached?
Migrant Y/N............How is population reached?
Hispanic Y/N........................................How is population reached?
IV Drug Users Y/N...............................How is population reached?
Teens Y/N.............................................How is population reached?
Men who have sex w/ men Y/N.........How is population reached?
Women of childbearing age Y/N......How is population reached?
African-American Y/N.........................How is population reached?
Homeless Y/N.....................................How is population reached?
Sex Workers Y/N.................................How is population reached?
Disabled Y/N.......................................How is population reached?
Mentally Ill Y/N.....................................How is population reached?
How is your staff trained to be sensitive in dealing with these special populations?

Patient Satisfaction

Now we want to ask you a few questions about how you think your clients feel about some of the issues we've been discussing with you.

In your opinion, do you think your clients/patients satisfied with...

... the timeliness of service delivery? Y N
... the way they are treated by district staff? Y N
... their ability to get to clinic locations for services? Y N
... the health department's ability to refer them to other services they need, if the HD cannot provide these services? Y/N
1. ... the health department's ability to address any special needs the patient may have?
... the way they were counseled before and after receiving test results?
1. Y N
... the way the health department addresses and handles confidentiality issues? Y/N
Do patients feel worried about confidentiality issues? Y/N
Do you conduct surveys to assess client satisfaction? Y/N
If so, how often do you do this? Every _______
Are the results used to improve your clients' access to health care?

Barriers

Now, we'd like to ask you about barriers that keep your clients/patients from adequately accessing health care. Please tell us if you consider the following issue to be a barrier for clients/patients in your district, and if so, why it is a barrier and what can be done to address it.

Transportation Y/N......................What is/can be done to address barrier?
Language Y/N..............................What is/can be done to address barrier?
Cultural Differences Y/N............What is/can be done to address barrier?
Fees for Services Y/N.................What is/can be done to address barrier?
Familiarity w/ Staff Y/N................What is/can be done to address barrier?
Clinic Locations Y/N...................What is/can be done to address barrier?
Hours of Operation Y/N.............What is/can be done to address barrier?
Understaffing Y/N.......................What is/can be done to address barrier?
Does staff training include components of how to deal with any of these barriers (i.e., cultural differences or language barriers)? Y/N

9a) If not, what additional training do you think is needed?

Process

We have just a few questions about the process by which clients access the health care system.

Do you conduct a clinic flow analysis? Y/N
(Average amount of time a patient completes the entire clinic process)
1. If so, how often? Every _______
Do you monitor the length of waits in waiting rooms? Y/N
How long do each of the following take during a typical patient's visit to the Health Department...(be sure to specify minutes, hours, etc.)

...Typical waits in waiting rooms? ________________________________________

...HIV/STD examination? _______________________________________________

...Pre-test counseling to occur? __________________________________________

...Patient's to get test results back for: Chlamydia? _________________________

Gonnorhea? _________________________

Syphilis? _________________________

HIV? _________________________

...For someone to be seen upon returning for HIV test results? __________________
...To be post-test counseled for HIV negative results? _________________________
...To be post-test counseled for HIV positve results, including partner eliciation or
interviewing? (Finding out patients' partners)___________________________
For the overall process, what would be an assessment of the total amount of time per individual visit?
How do you schedule clients? _____Appointment ______Walk-in ______Both?

6a) If both, does appointment v. walk-in affect timeliness of service provision?

6b) Which do you prefer?

Insurance Issues

The next few questions concern patient health insurance coverage.

Do the majority of patient health care plans that you frequently see cover the HIV/STD services that your department offers?
Are there any HIV/STD services that are not covered by the carriers that you see most often in your department?
What type of insurance coverage do you most frequently see in the clinics?
____Medicaid/Medicare

____Ryan White

____PPO

____None

____Private

____Don't Know

____HMO Other_________________

____Peach Care (Check all that apply)
Does your district maintain collaborative agreements with managed care health plans?
Do you encounter any barriers when trying to process forms or administer services relating to insurance coverage? Y N
5a) If so, what do you consider to be the greatest barrier?
Do patients generally know what HIV/STD services are covered by their insurance? Y/N
6a) If they have questions who can they talk to?
Have you noticed a change in the number or demographic make-up of individuals using your services since the transition from health care coverage to managed care coverage?

Fees for Services

The next few questions are about the fees patients are charged for HIV and STD services.

What is your fee scale for each HIV and STD service? (request a copy)
Are clients ever turned away due to inability to pay for services? Y/N

2a) If so, under what circumstances?

2b) If so, what happens to these clients? Are they referred elsewhere, turned away completely...?

Do the fees collected for HIV/STD services go back into the program? Y/N
How are patients informed or made aware that fees for services will be determined on their ability to pay?
Are patients aware of their right to public health care services regardless of their ability to pay?