Racial/ethnic and HIV risk category disparities in preexposure prophylaxis discontinuation among patients in publicly funded primary care clinics.

Objective: Dissemination of preexposure prophylaxis (PrEP) is a priority for reducing new HIV infections, especially among vulnerable populations. However, there are limited data available on PrEP discontinuation following initiation, an important component of the PrEP cascade.

Design: Patients receiving PrEP within the San Francisco Department of Public Health Primary Care Clinics (SFPCC) are included in a PrEP registry if they received a PrEP prescription, were not receiving postexposure prophylaxis, and not known to be HIV-positive.

Multivariate Risk Adjustment of Primary Care Patient Panels in a Public Health Setting: A Comparison of Statistical Models.

We compared prospective risk adjustment models for adjusting patient panels at the San Francisco Department of Public Health. We used 4 statistical models (linear regression, two-part model, zero-inflated Poisson, and zero-inflated negative binomial) and 4 subsets of predictor variables (age/gender categories, chronic diagnoses, homelessness, and a loss to follow-up indicator) to predict primary care visit frequency. Predicted visit frequency was then used to calculate patient weights and adjusted panel sizes.

Difference in Survival between Housed and Homeless individuals with HIV, San Francisco, 2002-2011.

San Francisco (SF), a city with large HIV-infected and homeless populations, expanded supportive housing for HIV-infected people in 2007. We used the SF HIV/AIDS registry to compare survival between people who were homeless and who were housed at time of HIV diagnosis from 2002 through 2011. Housing status was obtained from medical records and deaths from local, state, and national vital registration.

Assessing and increasing patient panel size in the public sector.

Context: Panel management is a central component of the primary care medical home, but faces numerous challenges in the safety net setting. In the San Francisco Department of Public Health, many of our community-based primary care clinics have difficulty accommodating all patients seeking care.

Objective: We evaluated patient panel size in our 7 clinics providing cradle-to-grave primary care services to more than 25,000 active patients.

Creating a medical home in the San Francisco department of public health: establishing patient panels.

Patients with a medical home tend to fare better. One of the first steps toward establishing a medical home is to create panels by designating a clinic responsible for each patient. In 2006, we defined active clinic panels (all patients assigned to a clinic and seen there for one or more outpatient medical visits during the past 2 years) for the San Francisco Department of Public Health's 13 community- and four public hospital-based primary care clinics and began automatically assigning previously unassigned patients to clinics based on utilization.