Barriers to social services for HIV-infected urban migrators.

Anecdotal accounts suggest that residency requirements often lead to denial of services at a time when HIV positive migrators are most in need of these services. However, this suspicion has never been empirically tested. Using needs assessment data collected for Harris County, Texas, this article examines eligibility and knowledge barriers faced by HIV positive recent migrators into Harris County. Results indicated that migration into the county was a significant predictor of failure to receive government-administered basic services such as food services but was not a significant predictor of failure to receive community based organization (CBO)-administered "specialized" services targeted specifically to HIV positive individuals. Results also indicated that migration was associated with knowledge barriers for all types of services.

Managed care, cost-effectiveness, and rehabilitation: the case of HIV.

Because of its cost-effective approach to impairment and disability, rehabilitation therapy is uniquely positioned to assume a significant role in today's healthcare environment. As the cost of health care has become a major concern, both the government and the private insurance industry have turned toward rehabilitation services as resources for preventing more costly use of the healthcare system in the future. Although funding in the area of injury research scarce, funding for demonstrating the success of therapies for chronic illness such as HIV is more plentiful. In the case of HIV, rehabilitation nursing techniques and principles can be used as a model for reducing the substantial social costs of the disease. Specifically, rehabilitation nurses can assume a leadership role as service coordinators for HIV-positive patients. If rehabilitation nurses perform this role effectively and participate fully in research efforts aimed at measuring the success of rehabilitation therapy, their efforts have the potential of permanently raising the status of the rehabilitation nursing specialty.

Motivating physician behaviour change: social influence versus financial contingencies.

The recent development of clinical practice heuristics is a logical consequence of outcomes and effectiveness research. Proponents of clinical practice guidelines (CPGs) believe they will lower costs, enhance quality, and reduce the incidence of malpractice claims. Although the process for generating CPGs appears relatively uncomplicated, guidelines alone do not produce lasting changes in physician behaviour. Discusses strategies for implementing CPGs based on the various factors that influence physician behaviour. Recommends direct behaviour management strategy based on financial contingencies.