Academic journal article Care Management Journals

A Review of HIV/AIDS Case Management Research

Academic journal article Care Management Journals

A Review of HIV/AIDS Case Management Research

Article excerpt

Published research on HIV/AIDS case management is reviewed. Twenty-five studies are placed within a conceptual framework that can be used to guide a research agenda. Unlike other case management fields, research in this field has not kept pace with the growth and development of HIV/AIDS case management. Reasons for the paucity of research in this field are offered.

Although case management is a well-established service modality for persons infected with and affected by HIV and AIDS, there has been relatively little published research over the past 10 years when case management for persons with AIDS, AIDS-related complex, and HIV was adopted as a critical intervention strategy and community and hospital-based programs rapidly expanded (National Commission on AIDS, 1991; Sonsel, Paradise, & Stroup, 1988). Unlike other fields of case management, especially mental health which has generated dozens of studies and a rich body of knowledge on the impact and effectiveness of case management services (see, for example, Chamberlain & Rapp, 1991; McCurrin & Worley, 1993; Modrcin, Rapp, & Poertner, 1988; Solomon, 1992), research on HIV/AIDS case management has failed to keep pace with the growth and development of the field. In this article, the author reviews the published research on HIV/AIDS case management and places the state-ofthe- art research as well as the much-needed research into a conceptual framework that could be used to guide a case management research agenda. In addition, some issues that may contribute to the difficulties in designing and implementing HIV/AIDS case management research are raised.

CONCEPTUAL FRAMEWORK

Research related to HIV/AIDS case management can b organized at four levels: clients, case managers, case management programs, and case management service delivery systems. This conceptual framework is presented in Figure 1. At each level, there are a number of associated topics that are, and can be, the foci of research. For example, at Level 1, client-focused research would examine individual characteristics that influence utilization or satisfaction with case management, and compliance with protocols. The growing interest in HIV/AIDS substance abusing populations falls within this category, as well as the adolescent Special Projects of National Significance (SPNS) project. Studies related to case managers, Level 2, are interested in worker perceptions, skills, roles, and functions. Level 3 research focuses on specific case management programs or models, and the factors that affect their implementation and/or effectiveness. These studies tend to be descriptive case studies. Level 4 studies of case management delivery systems examine planned regional or statewide approaches, and address research questions in regard to how integrated the service system is, whether it is cost-effective, and where there are gaps in or duplication of resources and services.

HIV/AIDS CASE MANAGEMENT RESEARCH

The first significant step in the development of HIV/AIDS case management and research of it was taken in 1986 by the Robert Wood Johnson Foundation (RWJF). The Foundation's establishment of 9 demonstration projects with case management as an integral component of its AIDS Health Services Programs also had a research agenda to assess the feasibility of developing community- based services for persons with AIDS, and to identify factors that facilitated or impeded service development and provision. This research remains today as the most comprehensive examination of HIV/AIDS case management (Fleishman, Mor, Piette, 1991; Mor, Piette, & Fleishman, 1989; Mor, Stein, Carpenter, & Mayer, 1997; Piette, Fleishman, Mor., & Dill, 1990; Piette, Fleishman, Mor, & Thompson, 1992; Piette, Thompson, Fleishman, & Mor, 1993).

A similar body of HIV/AIDS case management research should be forthcoming as a result of the 1993 SPNS Programs of the Health Resource Service Administration (HRSA). …

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