Abstract The objective of this study was to assess whether United States DHHS guidelines for treatment with antiretroviral therapies are being implemented by health care providers when discussing treatment options with newly diagnosed HIV patients. Health care providers were observed interacting with HIV patients while making decisions about treatment. Observers assessed whether providers and patients discussed the five benefits and six risks of initiating antiretroviral therapy, as recommended in the DHHS Guidelines. Preliminary results indicate that the DHHS Guidelines are not being implemented in the way they were intended. The risks and benefits of antiretroviral therapy were infrequently discussed. No more than four of the 11 risk/benefit items were discussed with any patient, and four of the six risk items were never mentioned to any patient. Potential reasons why the guidelines are not being implemented are discussed.
Research on variation in policy implementation has examined how individual- and organizational-level variables shape discretionary practices at the frontlines of implementation but has given less attention to the influence of the organizational field. From an institutional logics perspective, the practices of street-level workers are likely to be more congruent with policy intent when policy is consistent with the core institutional logic that structures the organizational field. Using data from a probability sample of 90 Los Angeles County HIV/AIDS health organizations and 216 frontline practitioners, our findings suggest that the extent to which implementation of HIV test counseling follows guidelines of the Centers for Disease Control and Prevention (CDC) is related to consistency between CDC policy and core institutional logic, when accounting for individual-level factors such as client need; practitioners' professional orientation, knowledge, experience, and training; and organizational constraints such as workload pressures and formalization.
The problem of succession is the organizational equivalent of the larger societal problem of generations. This chapter deals with a comparative analysis of the effects of succession on a military installation and a large business firm. Comparative analysis of military and industrial organization suggests that military organization has reached a stage of bureaucratic development which seemingly anticipates the future movement of other complex systems. Rotation in the military is from one unit to another within a single establishment. Military rotation policies require officers to change their assignments after a given period of time. Comparisons of business firms and military installations facilitate the study of the effects on succession of differential degrees of organizational control. The socialization for higher position of all managers, business and military, requires constant exposure to a large number of organizations. A comparatively slow rate of succession in the business firm studied seemed to function to produce homogeneity through shared experiences in the organization.
This paper examines the performance of 13 mobile testing units (MTUs) and rapid HIV testing technology in Los Angeles County as reflected in the relationship between the cognitive strategies used by MTU staff regarding instructions to clients about picking up their test results and returning for test results, and following up with those clients who did not return, and the spatial distribution of MTUs and AIDS rates in 2003. Maps were created using geographic information systems (GIS) data on 93 MTU testing locations and 2003 AIDS cases data. MTU staff (N = 45) were interviewed and several themes were identified. MTU testing locations were clustered near high AIDS rate areas. Staff reports were obtained on 24 clients in the past 6 months who received HIV-negative test results and 24 clients during the same time period who received HIV-positive test results. Staff strategies that were used included keeping clients with them while rapid test results were being processed and adjusting to clients' schedules when arranging for picking up test results. Some staff used tangible incentives such as vouchers for area businesses to encourage preliminary HIV-positive clients to return for confirmatory test results. Staff also sought to convince clients who preliminarily tested HIV-positive to convert from anonymous to confidential testing in order to facilitate clients' linkage to treatment. The GIS findings and client risk data support the Centers for Disease Control and Prevention policy of implementing MTUs and rapid testing in large urban communities with high AIDS rates.
Deux modeles theoriques destines a rendre compte de l'adaptation sociale et de l'utilisation des services sociaux par un echantillon de 971 adultes malades mentaux chroniques sont exposes, compares et commentee. Les malades mentaux dont il s'agit participent au NIMH Community Support Program mis sur pied a l'echelon federal pour aider les grands handicapes mentaux a «fonctionner» en dehors des institutions
Organizational commitment refers to the nature of the relationship of the member to the system as a whole. Two general factors which influence the strength of a person's attachment to an organization are the rewards he has received from the organization and the experiences he has had to undergo to receive them. The nature of one's commitment to an organization may undergo radical change depending on the relationship between belief and reality. Convergence of belief and reality would tend to strengthen commitment, while divergence should cause a decrease in commitment. Two barriers to upward mobility in the company are considered: formal education, which is an achieved characteristic; and sex, which is ascriptive. Specifically, it is hypothesized that within each career mobility level, managers who had overcome a barrier would be more fully committed to the corporation than those who had not.
This study examined HIV test counselors’ beliefs and practices regarding communicating indeterminate HIV test results to clients. There are many reasons for an indeterminate HIV antibody/ Western blot assay including early HIV infection, infection with other contagious diseases, autoimmune diseases, and second or subsequent pregnancies in women. Field observations of three community HIV testing sites and semistructured interviews with 16 HIV test counselors were conducted from August 2002 through June 2003. Counselors defined an indeterminate test result in different ways. They also presented several different theories of causation, yet failed to mention two potential causes of an indeterminate result, association with large animals and infection with other (non-HIV-1) HIV strains. Counselors’ understanding of the meaning of an indeterminate HIV test result varied a great deal. Some counselors believed that an indeterminate result truly was ambiguous while others believed it was indicative of being either HIV-positive or HIV-negative. Counselors’ primary advice to clients who received an indeterminate result was to retest immediately without a waiting period. Counselors reported that communicating indeterminate test results to clients was a challenging task because clients who received such a result were confused, angry, and/or mistrustful. Results highlight the need for further research to provide reliable estimates of the extensiveness of indeterminate HIV test results and to further assess the nature of counselor and client responses to indeterminate test results.
Succession is a universal organizational process and therefore important for a comparative analysis of organizations. A review of published research indicated that succession tends to be a disruptive process. The small role-system of which the successor is a part and key characteristics of the whole organization's structure influence the degree of instability promoted by succession.
