|Section I: (+) HIV Clinic & (+) MDM (Areas of overlap)|
|a) Care continuity through coordinated teamwork||
1. Patient: So this is one thing we really appreciate is the team approach to everything. So, you know, we know that first we’re going to meet with the nurse and go through all of our stuff, and then we know, you know, we’re going to meet with doctor and then meet with the pharmacist. So I mean, we appreciate that … that it feels like total care. (Female; 40–49 years old)|
2. Clinician: I think that it’s … that team approach is good for patients. Rather than saying—well now I want you to go see a pharmacists down in the pharmacy, and they wouldn’t go. Had we been able to get their shots right here, they’d get them.
|b) Social lives and stigma consideration||
1. Patient: This disease is so much more mental than it is physical, sometimes. That’s where the difference they have made, because I’ve never felt like a pariah or like, you know, the outside world view of HIV and AIDS, And you never, ever, ever felt like that in these rooms by anybody I’ve talked to, been next too, got blood from, whatever; I’ve never felt that a smidge. The stigma...Yeah, no stigma at all from when you enter this building to when you walk out, and that’s huge, because I’d be the guy that wouldn’t come back if I felt that. That’s what makes it a safe place. (Male; 50–59 years old)|
2. Clinician: normalizing that experience with HIV is a huge thing of what we do here … and … we can only do so much here in the clinic … we can at least make this a safe place for it. Changing the whole attitude towards HIV elsewhere is … can be a life-long task … until we do it … yeah”
|Section II: (−) HIV Clinic & (+) MDM (Present in MDM, but missing in the HIV clinic)|
|a) Understanding life’s technicalities is not the same as biographical support||
1. Patient: So if I’m only going to live a couple weeks, I don’t care. If I’m going to live for a year, I don’t really care (laughs). But … if I’m going to live longer...I need to figure out how to cope with it. (Male; 70–79 years old)|
Patient’s caregiver: And that’s why I think, maybe, the social workers could. . .they did. . I mean they have offered. We just weren’t ready last time.
2. Patient: I lost everything. I lost my house. I lost of couple of family. I lost some friends. You know. .. I lost my landlord; she was a good person. She treated me like I was her son. You know, you miss that. You know, I mean they’re all back home. I had a home, you know. I miss so much back home, you know.
Interviewer: Do you discuss these things here when you come? Do you talk to your clinician about that?
Patient: No, no. (Male; 40–49 years old)
3. Clinician: I mean, unless they bring it up, it’s like. .. so I guess I ask—how are you doing. .. but that’s pretty open. And some people will share something, but I feel like the clinic visits are so long. .. . that some people just don’t. .. . they just want to see you and get moving onto the next person because they already know they’re going to be here a long time.
|b) Danger in delegation of social issues||
1. Clinician: Sometimes it turns into … some of our folks that are in case management … um … it almost feels like … eh … dependent relationship” “for them to be able to function more independently is very difficult for them, and they really needed to have that person (social worker) to help them navigate through that complex world of medical appointments and etc.|
2. Clinician: That is what I do and typically for the patient there is a couple of reschedules before they actually see a doctor and they feel bad calling … So, it is they start to feel like “I need to have that person there to help or I will just run into that barrier … and then they get frustrated and kinda give up. It can be challenging as a case manager to try not have that real dependence...dependency build up with the patient so we can they can still feel that, yes, they can do, and that I am here as a support”
|c) Needless work and needing social support||
1. Patient: So, I’ve been having a lot of appointments here at the clinic, and it’s just that I don’t want to keep coming back if it’s not going to accomplish something. These visits just to see how things are going, you know, they could find that out with a phone call.(Male; 60–69 years old)|
2. Clinician “One of the barriers of the team approach is that, I think … we all are important, we all wanna see the patients … .but sometimes I think, it gets overlapped, and then … eh … we even are providing sometimes too much to some patient that maybe the needs aren’t there”
3. Patient: [Another clinic] had just resources on the walls available, like not necessarily specific to the clinic, even just social support, which I feel, sure I get support for my own here, but outside of here, I don’t feel like there’s support or resources to get that support. (Male; 50–59 years old)
|Section III: (+) HIV & (−) MDM (Present in the HIV clinic, worth incorporating into MDM)|
|a) Enabling factors to work-life harmony||
1. Clinician: I’m quite happy with my work-life balance. The clinic is typically a busier day, but not to a point that I’ve ever had an issue.|
2. Clinician: So in that area in XXXX, they had way more visits, and the pharmacists couldn’t see everybody cuz they only had one pharmacist for the unit. ... the one unit or area. So the pharmacy visits are typically tiered or selected by the providers, so that’s a little bit different, whereas here, a pharmacist is seeing every patient, reviewing every patient, and that’s beneficial.
|b) Privacy and professionalism||
1. Patient: So while we were waiting for our appointment here, we saw two different people in XXXX, and I can tell you the quality of care that we’ve gotten here ten times surpasses the quality of care we got there.|
Interviewer: So I want to ask you—what is different. .. what did you view different between here (this clinic) and there (the previous clinic you attended)?
Patient’s caregiver: Um, I mean straight up, out of the two, I would say honestly its level of knowledge. I mean, hands down. You know, it’s truly expertise, know-how; they just really...
Patient: And professionalism, I would say. (Female; 40–49 years old)