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Qualifications, Demographics, Satisfaction, and Future Capacity of the HIV Care Provider Workforce in the United States, 2013-2014.

ABSTRACT: BACKGROUND:The human immunodeficiency virus (HIV)-infected population in the United States is increasing by about 30 000 annually (new infections minus deaths). With improvements in diagnosis and engagement in care, additional qualified HIV care providers may be needed. METHODS:We surveyed a probability sample of 2023 US HIV care providers in 2013-2014, including those at Ryan White HIV/AIDS Program (RWHAP)-funded facilities and in private practices. We estimated future patient care capacity by comparing counts of providers entering and planning to leave practice within 5 years, and the number of patients under their care. RESULTS:Of surveyed providers, 1234 responded (adjusted response rate, 64%): 63% were white, 11% black, 11% Hispanic, and 16% other race/ethnicity; 37% were satisfied/very satisfied with salary/reimbursement, and 33% were satisfied/very satisfied with administrative time. Compared with providers in private practice, more providers at RWHAP-funded facilities were HIV specialists (71% vs 43%; P < .0001) and planned to leave HIV practice within 5 years (11% vs 4%; P = .0004). An estimated 190 more full-time equivalent providers (defined as 40 HIV clinical care hours per week) entered practice in the past 5 years than are expected to leave in the next 5 years. If these rates continue, by 2019 patient care capacity will increase by 65 000, compared with an increased requirement of at least 100 000. CONCLUSIONS:Projected workforce growth by 2019 will not accommodate the increased number of HIV-infected persons requiring care. RWHAP-funded facilities may face attrition of highly qualified providers. Dissatisfaction with salary/reimbursement and administrative burden is substantial, and black and Hispanic providers are underrepresented relative to HIV patients.

SUBMITTER: Weiser J

PROVIDER: S-EPMC5058419 | biostudies-literature | 2016 Oct

REPOSITORIES: biostudies-literature

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Qualifications, Demographics, Satisfaction, and Future Capacity of the HIV Care Provider Workforce in the United States, 2013-2014.

Weiser John J Beer Linda L West Brady T BT Duke Christopher C CC Gremel Garrett W GW Skarbinski Jacek J

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20160629 7

<h4>Background</h4>The human immunodeficiency virus (HIV)-infected population in the United States is increasing by about 30 000 annually (new infections minus deaths). With improvements in diagnosis and engagement in care, additional qualified HIV care providers may be needed.<h4>Methods</h4>We surveyed a probability sample of 2023 US HIV care providers in 2013-2014, including those at Ryan White HIV/AIDS Program (RWHAP)-funded facilities and in private practices. We estimated future patient ca ...[more]

PMID: 27358352

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Project description:ObjectiveTo assess changes in engagement with online tobacco and electronic cigarette (e-cigarette) marketing (online tobacco marketing) among adolescents in the United States between 2013 and 2015.MethodsWe assessed the prevalence of six forms of engagement with online tobacco marketing, both overall and by brand, among adolescents sampled in Wave 1 (2013-2014; n = 13651) and Wave 2 (2014-2015; n = 12172) of the nationally representative Population Assessment for Tobacco and Health Study. Engagement was analyzed by tobacco use status: non-susceptible never tobacco users; susceptible never tobacco users; ever tobacco users, but not within the past year; and past-year tobacco users.ResultsAmong all adolescents, the estimated prevalence of engagement with at least one form of online tobacco marketing increased from 8.7% in 2013-2014 to 20.9% in 2014-2015. The estimated prevalence of engagement also increased over time across all tobacco use statuses (eg, from 10.5% to 26.6% among susceptible adolescents). Brand-specific engagement increased over time for cigarette, cigar, and e-cigarette brands.ConclusionEngagement with online tobacco marketing, both for tobacco and e-cigarettes, increased almost twofold over time. This increase emphasizes the dynamic nature of online tobacco marketing and its ability to reach youth. The Food and Drug Administration, in cooperation with social networking sites, should consider new approaches to regulate this novel form of marketing.ImplicationsThis is the first study to estimate the national prevalence of engagement with online tobacco marketing among adolescents over time. The estimated prevalence of this engagement approximately doubled between 2013-2014 and 2014-2015 among all adolescents and, notably, among adolescents at relatively low risk to initiate tobacco use. This increase in engagement could represent public health harm if it results in increased initiation and use of tobacco products. Stronger federal regulation of online tobacco marketing and tighter control of access to tobacco-related content by social media sites could reduce adolescents' exposure to and engagement with online tobacco marketing.

Project description:BackgroundHuman immunodeficiency virus (HIV)-experienced clinicians are critical for positive outcomes along the HIV care continuum. However, access to HIV-experienced clinicians may be limited, particularly in nonmetropolitan areas, where HIV is increasing. We examined HIV clinician workforce capacity, focusing on HIV experience and urban-rural differences, in the Southern United States.MethodsWe used Medicaid claims and clinician characteristics (Medicaid Analytic eXtract [MAX] and MAX Provider Characteristics, 2009-2011), county-level rurality (National Center for Health Statistics, 2013), and diagnosed HIV cases (AIDSVu, 2014) to assess HIV clinician capacity in 14 states. We assumed that clinicians accepting Medicaid approximated the region's HIV workforce, since three-quarters of clinicians accept Medicaid insurance. HIV-experienced clinicians were defined as those providing care to ≥ 10 Medicaid enrollees over 3 years. We assessed HIV workforce capacity with county-level clinician-to-population ratios, using Wilcoxon-Mann-Whitney tests to compare urban-rural differences.ResultsWe identified 5012 clinicians providing routine HIV management, of whom 28% were HIV-experienced. HIV-experienced clinicians were more likely to specialize in infectious diseases (48% vs 6%, P < .001) and practice in urban areas (96% vs 83%, P < .001) compared to non-HIV-experienced clinicians. The median clinician-to-population ratio for all HIV clinicians was 13.3 (interquartile range, 38.0), with no significant urban-rural differences. When considering HIV experience, 81% of counties had no HIV-experienced clinicians, and rural counties generally had fewer HIV-experienced clinicians per 1000 diagnosed HIV cases (P < .001).ConclusionsSignificant urban-rural disparities exist in HIV-experienced workforce capacity for communities in the Southern United States. Policies to improve equity in access to HIV-experienced clinical care for both urban and rural communities are urgently needed.

Project description:IntroductionThis paper reports the key findings of the Faculty of Radiation Oncology 2014 workforce census and compares the results with earlier surveys.MethodsThe census was conducted in mid-2014 with distribution to all radiation oncologists, educational affiliates and trainees listed on the college database. There were six email reminders and responses were anonymous. The overall response rate was 76.1%.ResultsThe age range of fellows was 32-96 (mean = 49 years, median = 47 years). The majority of the radiation oncologists were male (n = 263, 63%). The minority of radiation oncologists were of Asian descent (n = 43, 13.4%). Radiation oncologists graduated from medical school on average 23 years ago (median = 22 years). A minority of fellows (n = 66, 20%) held another postgraduate qualification. Most radiation oncologists worked, on average, at two practices (median = 2, range 1-7). Practising radiation oncologists worked predominantly in the public sector (n = 131, 49%), but many worked in both the public and private sectors (n = 94, 37%), and a minority worked in the private sector only (n = 38, 14%). The largest proportion of the workforce was from New South Wales accounting for 29% of radiation oncologists. Radiation oncologists worked an average of 43 h/week (median = 43 h, range 6-80). Radiation oncologists who worked in the private sector worked less hours than their public sector or public/private sector colleagues. (38.3 vs. 42.9 vs. 44.3 h, P = 0.042). Victorians worked the fewest average hours per week at 38 h and West Australians the most at 46 h/week. Radiation oncologists averaged 48 min for each new case, 17 min per follow up and 11 min for a treatment review. Radiation oncologists averaged 246 new patients per year (median = 250, range = 20-600) with men (average = 268), Western Australians (average = 354) and those in private practice seeing more (average = 275). Most radiation oncologists considered themselves as specialists (n = 151, 60%), but nearly all those from South Australia were generalists (n = 15, 94%) as were three-quarters of those from private practice. A minority of radiation oncologist respondents (10%) intended to retire within 5 years with a further 16% within 10 years.There was a stabilisation of trainee numbers in Australia and New Zealand with no increase compared with 2010 (142 in 2014 vs. 143 in 2010). The most common age bracket for trainees remained 31-35 years. One-third of trainees were of Asian descent and nearly half held other degrees. The majority of trainees were satisfied with their career, but 30% were not entirely satisfied. Nearly half of trainee respondents would have reconsidered their choice of specialty had they known about the possible oversupply in the workforce with 12.4% undecided about continuing their career in radiation oncology. There were still 16% of trainees with no protected time during the working week, and a further 21% with only 1 h. Only one trainee respondent preferred to work in private practice, and job availability remained a concern for 89% of respondents.ConclusionsThe radiation oncologist workforce numbers have increased at a much slower rate, and unemployment remained low. Many parameters remained similar to the 2010 survey. However, there has been a decrease in the average number of new patients seen per year, working hours and also a slight decrease in the time spent per new patient. The trainee numbers have stabilised, but job availability remained a concern. A significant proportion of trainees were not satisfied with their career.

Project description:BackgroundNoncigarette tobacco products are evolving rapidly, with increasing popularity in the United States.MethodsWe present prevalence estimates for 12 types of tobacco products, using data from 45,971 adult and youth participants (≥12 years of age) from Wave 1 (September 2013 through December 2014) of the Population Assessment of Tobacco and Health (PATH) Study, a large, nationally representative, longitudinal study of tobacco use and health in the United States. Participants were asked about their use of cigarettes, e-cigarettes, traditional cigars, cigarillos, filtered cigars, pipe tobacco, hookah, snus pouches, other smokeless tobacco, dissolvable tobacco, bidis, and kreteks. Estimates of the prevalence of use for each product were determined according to use category (e.g., current use or use in the previous 30 days) and demographic subgroup, and the prevalence of multiple-product use was explored.ResultsMore than a quarter (27.6%) of adults were current users of at least one type of tobacco product in 2013 and 2014, although the prevalence varied depending on use category. A total of 8.9% of youths had used a tobacco product in the previous 30 days; 1.6% of youths were daily users. Approximately 40% of tobacco users, adults and youths alike, used multiple tobacco products; cigarettes plus e-cigarettes was the most common combination. Young adults (18 to 24 years of age), male adults and youths, members of racial minorities, and members of sexual minorities generally had higher use of tobacco than their counterparts.ConclusionsDuring this study, 28% of U.S. adults were current users of tobacco, and 9% of youths had used tobacco in the previous 30 days. Use of multiple products was common among tobacco users. These findings will serve as baseline data to examine between-person differences and within-person changes over time in the use of tobacco products. (Funded by the National Institute on Drug Abuse and the Food and Drug Administration.).

Project description:At least 2.3 million people in the U.S. have an opioid use disorder, less than 40% of whom receive evidence-based treatment. Buprenorphine used as part of medication-assisted treatment has high potential to address this gap because of its approval for use in non-specialty outpatient settings, effectiveness at promoting abstinence, and cost effectiveness. However, less than 4% of licensed physicians are approved to prescribe buprenorphine for opioid use disorder, and approximately 47% of counties lack a buprenorphine-waivered physician. Existing policies contribute to workforce barriers to buprenorphine provision and access. Providers are reticent to prescribe buprenorphine because of workforce barriers, such as (1) insufficient training and education on opioid use disorder treatment, (2) lack of institutional and clinician peer support, (3) poor care coordination, (4) provider stigma, (5) inadequate reimbursement from private and public insurers, and (6) regulatory hurdles to obtain the waiver needed to prescribe buprenorphine in non-addiction specialty treatment settings. Policy pathways to addressing these provider workforce barriers going forward include providing free and easy-to-access education for providers about opioid use disorders and medication-assisted treatment, eliminating buprenorphine waiver requirements for those licensed to prescribe controlled substances, enforcing insurance parity requirements, requiring coverage of evidence-based medication-assisted treatment as essential health benefits, and providing financial incentives for care coordination across healthcare professional types-including behavioral health counselors and other non-physicians in specialty and non-specialty settings. SUPPLEMENT INFORMATION:This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

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Qualifications, Demographics, Satisfaction, and Future Capacity of the HIV Care Provider Workforce in the United States, 2013-2014.

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Qualifications, Demographics, Satisfaction, and Future Capacity of the HIV Care Provider Workforce in the United States, 2013-2014.

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