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HIV medical providers’ knowledge of ACA varies
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Medical providers serving patients with HIV showed gaps in understanding the Affordable Care Act, or ACA, according to survey results published in Clinical Infectious Diseases.
“The ACA’s interaction with the current HIV health care delivery system is complex,” Kathleen A. McManus, MD, assistant professor of medicine at the University of Virginia, told Infectious Disease News. “With the goal of exploring HIV medical providers’ knowledge and attitudes about the ACA, we surveyed just over 250 HIV medical providers across the nation.”
McManus and colleagues initially surveyed 1,203 HIV medical providers using an online survey.
They asked if the ACA:
- provides subsidies for people with low income to purchase health insurance;
- makes it illegal to exclude someone from an insurance plan due to a pre-existing condition;
- eliminates the Ryan White HIV program; and
- has expanded the ACA’s optional Medicaid expansion in the physician’s state.
In all, 253 medical providers responded (21% response rate), with the majority of respondents being attending physicians (67.6%). Nearly the same percentage of respondents reported providing HIV care for less than 5 years and providing HIV care for more than 20 years (29.6% and 28.5%, respectively).
A majority of respondents — 61% — answered all survey questions correctly, whereas approximately one-third of participants answered “I don’t know” to at least one question.
Most (71%) knew if their state had decided to expand Medicaid, and 91% knew that the ACA does not eliminate the Ryan White program.
When they were asked to rate whether the ACA would improve patients’ HIV outcomes, using a scale of 1 to 5, with 5 as “strongly agree,” the providers’ mean responses varied by state Medicaid status, with providers in Medicaid expansion states more strongly agreeing (3.78; standard deviation [SD], 0.83) compared with providers in Medicaid nonexpansion states (3.37; SD, 1.00; P = .002).
When the researchers adjusted for medical provider type, years of HIV practice and sources of HIV information, they found the respondents’ correct ACA knowledge was associated with providing care in a Medicaid nonexpansion state (adjusted OR = 2.07: 95% CI, 1.11-3.88), obtaining knowledge from case managers (aOR = 1.89; 95% CI, 1.03-3.48) and acquiring knowledge from newspapers or magazines (aOR = 1.94: 95% CI, .99-3.81).
Thirty-two percent of respondents reported learning ACA information from their patients.
“There are knowledge gaps in HIV medical providers’ understanding of the ACA, and education should be disseminated to enhance systems-based practice,” McManus said. “Systems-based practice has been recognized by the Accreditation Council for Graduate Medical Education and by recent reviews on standards for excellent infectious disease clinicians. Courses in medical school, residency and fellowship, as well as courses offering CME credits, should address information about the ACA and Medicaid expansion so that medical providers can help their patients with the increasingly complex system.” – by Bruce Thiel
Disclosure: McManus reports stock ownership in Gilead Sciences. The other authors report no relevant financial disclosures.
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