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Transportation
Transportation is an essential service for our clients. Available community resources for
transportation are limited, especially in rural areas. Without transportation, individuals are not
able to access medical, case management, mental health, oral health, or substance abuse services.
The unavailability of infectious disease doctors in rural areas creates more transportation
problems since rural clients must travel great distances to access care. Many rural clients may
not have cars or family members available for transportation. Public transportation is virtually
non-existent in rural communities. Illinois will be conducting a provider profile to determine the
availability of other local resources in all areas of the state. Where public transportation is not
available, there may be other transportation resources that are not aware of the need and are
willing to work with program. This is one step in addressing the ongoing gap in transportation.
Delivery of Services
The way services are delivered can affect treatment outcome more than any other variable. The
needs assessments noted concerns with cultural competence. Workgroup participants noted
issues with cultural competence and work competence. One participant noted that “…lack of
knowledge among doctors and hurtful discriminatory attitudes by physicians can be detrimental
to treatment adherence.” Another participant noted that language barriers and not being served
by people who look like you creates issues for clients in treatment. Clients served by teaching
institutions listed that these institutions have several different doctors; patients see a different
doctor each time and constantly have to repeat the history. Lack of sufficient staffing results in
staff turnover which impacts patient attendance. It is necessary to collect basic information each
time a patient is seen because there is no continuity with providers. Clients also reported
problems with timely referrals from providers and that providers are not collaborating to
determine ways to provide effective continuum of care.
Staff will sometimes assume that all clients speak English or that all clients can read and
comprehend questionnaires. Some clients noted that being handed a long questionnaire and pen,
then left to figure it out is often overwhelming and is discouraging. All clients are not
empowered to speak for themselves and fear repercussion if they do.
Some participants shared a concern with the delivery of medications through ADAP. ADAP
requires patients to use the mail-order pharmacies, which creates a problem for some clients.
They perceive that when people go to mail-order pharmacies neither a doctor nor pharmacist is
involved in their care. Participants also believe that mail-order pharmacists have little or no
training regarding HIV medications or the importance of medication adherence. When clients
use mail-order pharmacies; they do not receive adherence counseling. To enhance the quality of
life for PLWHA, a doctor and a pharmacy must be involved in care. Another issue arises when
using a local store pharmacy. At pharmacies such as those in stores, privacy can be an issue.
The pharmacist may not provide necessary information about a drug and the consumer may feel
hesitant about discussing medications standing at the counter. Client education in this area may
relieve some of the misperceptions concerning provider knowledge. Additionally, providers of
mail order pharmaceuticals should receive training to be able to answer basic questions
concerning medication adherence.
