Showing papers in "Journal of Health Care for the Poor and Underserved in 2004"

Structural violence and racial disparity in HIV transmission.

Abstract: Among women of color in the United States, infection with the human immunodeficiency virus (HIV) is rising. Most of the research on this topic, however, has focused on individual-level risk factors, which do not fully explain racial or ethnic differences in infection rates. This article uses structural violence as a conceptual framework to examine ecological-level risk factors leading to disparate rates of heterosexually transmitted HIV among women of color in Syracuse, New York. Three ecological pathways to disproportionate infection are discussed: community rates of infection, concurrent partnerships, and increased vulnerability. The discussion of the pathways considers the following macro- level risk factors: disproportionate incarceration rates of African American men, residential segregation, gang turf, constraints on access to sexually transmitted disease services, an African American sex ratio in which women outnumber men, social norms stigmatizing homosexuality, and commercial sales of douching products. The authors argue that health care providers and policy analysts must address ecological-level risk factors for HIV transmission in underserved communities.

Attitudes and Beliefs Among Mexican Americans About Type 2 Diabetes

Abstract: Hispanics in the United States have a disproportionately high risk for non-insulin-dependent diabetes mellitus (type 2 diabetes) compared with non-Hispanic whites. Little is known of the attitudes and beliefs about diabetes in this group. Using data from six focus groups of 42 Mexican Americans (14 men and 28 women), we characterized perceptions about the causes of and treatments for type 2 diabetes. Many participants believed diabetes is caused by having a family history of the disease, eating a diet high in fat or sugar, and engaging in minimal exercise. Experiencing strong emotions such as fright (susto), intense anger (coraje), or sadness and depression (tristeza) was also thought to precipitate diabetes. Nearly all participants expressed the belief that it is important to follow doctors' recommendations for diet and exercise, oral medication or insulin; many also cited herbal therapies, such as prickly pear cactus (nopal) and aloe vera (savila) as effective treatments. These findings may be useful in designing interventions to reduce the burden of diabetes in Hispanic populations.

Patient health status and appointment keeping in an urban community health center.

Abstract: This study examines the relationship between patient health status and the likelihood of missing appointments in a community health center serving low-income patients. Medical records of 465 adult patients scheduled to be seen during one week in February 1999 were audited for an 18-month period. Seventy-three percent of patients failed to keep one or more appointments; 43% missed one or two; 30% missed three or more. Health status measures significantly associated with missing appointments included depression (p = 0.03), anxiety/panic disorder (p = 0.03), and using tobacco (p = <0.001). Linear regression analysis indicated that the number of appointments scheduled and of diagnosed psychological conditions, as well as patient age were significant predictors of missed appointments. Patient appointment keeping is predictable; definable, measurable characteristics of patients can contribute to setting priorities for customizing interventions.

Providers' Perspectives and Beliefs Regarding Transition to Adult Care for Adolescents with Sickle Cell Disease

Abstract: Until recently, few children with chronic illnesses such as sickle cell disease (SCD) lived past late adolescence. Substantial reductions in mortality mean a growing number of adolescents with SCD reach adulthood. Consensus among researchers and health care providers (HCP) from multiple disciplines is that critical attention to and more empirical research on the transition from pediatric to adult care is needed. We address the following questions: (1) How do pediatric and adult providers demonstrate involvement in transition? (2) What is expected of adolescents when they move to adult care? and (3) Do providers think there is a need for a systematic transition program? A cross-sectional, multi-format survey research study utilizing open-ended and forced-choice questions was conducted to compare responses between pediatric and adult providers from multiple disciplines. Data were collected from 227 HCP in three waves. Significant bivariate results (p < 0.05) reflected differing opinions regarding transition expectations and program need, especially among female providers, those practicing in urban areas, and providers who treat both adolescent and adult clients in comparison with their counterparts. Discussion includes implications for program development, social service and public health practice, and future research.

An exploration of patients' trust in physicians in training

Abstract: Several characteristics associated with patient trust are identified. To determine the level of trust patients from disadvantaged circumstances have in their primary care resident physician, and to determine patient and physician characteristics that predict trust, we administered a survey to randomly selected primary care patients of an academic medical center staffed by internal medicine residents after a visit to their primary care provider. Participants were adults. The group was racially diverse (50% non-white), English-speaking, and from lower socioeconomic groups. The 10-page survey consisted of 7 sections (Physician Trust Scale, Patient Demographics, Patient Health and Well-Being, Patient-Physician Relationship Characteristics, Global Doctor Trust Scale, and Physician Characteristics). The average trust score for primary care providers was 42.70 (standard deviation [SD] 6.20, maximum possible 50). Patient trust was associated with female gender of the participant, higher education level, male physician, and gender concordance between physician and patient, and was inversely related to patient age. Trust in the doctors and nurses at the hospital in which the clinic was located also had a positive association with trust. These patients from lower socioeconomic groups had relatively high levels of trust compared with patients from higher socioeconomic groups discussed in the literature.

How do urban African Americans and Latinos view the influence of diet on hypertension

Abstract: Uncontrolled hypertension and its complications continue to be major health problems that disproportionately affect poor minority communities. Although dietary modification is an effective treatment for hypertension, it is not clear how hypertensive minority patients view diet as part of their treatment, and what barriers affect their abilities to eat healthy diets. We conducted nine focus groups with 88 African American and Latino patients treated for hypertension to assess their knowledge, attitudes, behaviors, and beliefs concerning hypertension. Participants generally agreed that certain foods and food additives play an important role in the cause and treatment of hypertension. However, they found clinician-recommended diets difficult to follow in the context of their family lives, social situations, and cultures. These diets were often considered expensive, an unwelcome departure from traditional and preferred diets, socially isolating, and not effective enough to obviate the need for medications. These findings suggest the importance of culturally sensitive approaches to dietary improvements.

Low-income women's use of substance abuse and mental health services.

Abstract: This paper examines the utilization of mental health, alcohol, and drug treatment in a sample of low-income women. We analyze data from the Women's Employments Study, a study examining the barriers to employment for welfare recipients, and compare prevalence rates of mental health disorders and service utilization with the National Comorbidity Survey. Fewer than one in five of the respondents with a current mental health and/or substance dependence problem in the Women's Employment Study (WES) received treatment in the past 12 months. A logistic regression model of the association among demographic variables, risk factors, and service utilization in the WES found that having a co-occurring substance dependence and mental health disorder was significantly associated with receiving treatment. Those respondents with an increased number of barriers were significantly less likely to receive treatment. The authors argue that the success of welfare reform may hinge on low-income women's access to and utilization of appropriate services.

Free clinics helping to patch the safety net

Abstract: For the uninsured and underinsured with few funds, there are a limited number of health care options. To assist in filling this hole in the safety net, hundreds of free or volunteer-based clinics have been established across the country. Although these clinics have existed for years, little data on them exist. In 1999, a mail survey was sent to free clinics in seven Midwestern states. Findings from this survey show that, in a single year, these 106 clinics provided medical, dental, and pharmaceutical services to over 200,000 patients, suggesting that free clinics nationwide are caring for a substantial number of our nation's uninsured. The survey paints a picture of free clinics, the populations they serve, and the services they provide. Given the lack of options for the uninsured and underinsured, free clinics deserve continued recognition, support, and assistance from policy makers, health care providers, and the philanthropic community.

Health risk and promotion behaviors in refugee populations.

Abstract: Refugees resettling in the U.S. are generally low-income and underserved by health promotion interventions. To begin to address refugee health promotion issues, this study describes health behaviors of newly arrived (less than 90 days) adult refugees in the U.S. The methods used were retrospective description of clients from one refugee health screening program. The sample consisted of adult refugees (n=591), men and women, from Cuba, Bosnia, Vietnam, Kosovo, Iran, Iraq, and other countries. Rates of overweight were highest among Bosnians and lowest among Vietnamese. Cubans reported the most physical activity and Kosovars the least. Rates of smoking were highest among Bosnians and lowest among Cubans. Older refugees were more overweight and reported less physical activity and more smoking than younger adults. In some cases, different refugee groups have similar health promotion needs, while in others needs differ. This baseline descriptive data supports calls for further health promotion research and interventions in refugee populations.

Self-Reported Health of Residents of the Mississippi Delta

Abstract: The rural Lower Mississippi Delta of Arkansas, Louisiana, and Mississippi has a large economically and socially disadvantaged population at high risk for health problems. Their health status is poorly understood as they are not well represented in national health surveys. A random-digit-dialing telephone survey was conducted in 2000, with 2,236 respondents representing residents of 36 counties along the Mississippi River. Self-reported chronic conditions, health status, and obesity (derived from weight and height) were compared with the nationally representative Continuing Survey of Food Intake of Individuals. High cholesterol, diabetes, and hypertension were significantly higher than in the national sample. Obesity was strikingly higher in Delta children (27.9% versus 16.2%) of all ages and in Delta adults (33.9% versus 17.3%). Controlling for age, income, and gender, African Americans were at particular risk for obesity, hypertension, and diabetes. A public health crisis appears to exist in the Delta given the high prevalence health problems.

Mammography Rescreening Among Women of Diverse Ethnicities: Patient, Provider, and Health Care System Factors

Abstract: This study identified patient, provider, and health care system factors that influenced mammography rescreening among non-insured, racial/ethnic minority women. Data were collected using a stratified-clustered random sample survey of 1,050 women of five racial/ethnic groups (Latina, Chinese, Filipina, African American, and Caucasian) and 102 primary care clinical sites. Women received screening services through two no-cost screening programs in California. Chi-square tests were used to assess bivariate associations and multiple logistic regressions were used to compute adjusted odds ratios and 95% confidence intervals. Mammography rescreening was associated with living in the United States longer; having higher education levels, better health care access, a history of breast problems, and favorable perceptions of mammography; obtaining regular Pap screening and hormone replacement therapy; having had better communication with clinicians; and attending clinics that conducted in-reach activities. This study suggests that simply removing financial barriers is not enough to improve mammography rescreening among underserved women.

Churning in Medicaid managed care and its effect on accountability.

Abstract: There is concern that churning in Medicaid excludes children from the accountability system for managed care because they may not meet the one-year continuous enrollment requirement. This study explores the effect of churning in measuring childhood immunization coverage rates under the current accountability system. Data were collected from administrative databases at the Centers for Medicaid and Medicare Services and 12 states with high Medicaid managed care penetration. On average in the 12 states only 39% of the children enrolled in one specific managed care plan met the continuous enrollment requirement. However, Centers for Medicaid and Medicare Services data showed that 78% of children were enrolled in Medicaid (but not the same plan) continuously for 12 months. Both plan-specific rates and overall Medicaid rates varied greatly across the states. Policies that result in churning mean that many vulnerable children fall outside of the accountability structure intended to assure that they receive necessary services.

Colorectal cancer screening among a sample of community health center attendees.

Abstract: To determine the rate of colorectal cancer screening in patients attending a sample of community health centers, medical records of 1,176 patients from eight community health centers were abstracted. Among the patients studied, 43.8% of patients had undergone at least one of the three colorectal screening tests (fecal occult blood test, colonoscopy, or flexible sigmoidoscopy) in the recommended interval. Colorectal screening in this community health center population was predicted by male gender, being African American, older age, having a greater number of chronic illnesses, a family history of colorectal cancer, and by having engaged in other preventive cancer screenings in the previous year. Although screening rates certainly were not optimal, they compare favorably to rates reported in national surveys for the general population. Our results add to a growing body of evidence that community health centers, despite serving disadvantaged populations, are able to deliver preventive care at rates comparable to health facilities used by the general population.

Characteristics of patients at three free clinics

Abstract: This study examined factors associated with the use of three free clinics located in Central Massachusetts. A total of 248 patients completed a questionnaire during the 2- month study period. Descriptive results showed a majority of free clinic patients are low- income, uninsured, and female. Many patients (62%) do not have a usual source of care, nor do they know where to go if the clinic is not open (61%). Most (82%) report using free clinics because they lack insurance. Patients who had been using the free clinics longer than 1 year are more likely to use the clinic because of inadequate insurance (p = 0.002) and as a way to obtain prescription drugs (p < 0.001). Although they serve an important need, free clinics cannot provide comprehensive, continuous care. Efforts to provide health care to the medically underserved must take these findings into consideration if they are to be successful.

The impact of acculturation on smoking in Asian American homes.

Abstract: This study examined the relationship between acculturation and smoking in Asian American homes and the factors that predict whether Asian Americans have family members or visitors smoking in the home. A sample of 1,374 participants was selected using a stratified-cluster proportional sampling technique. Overall, 38.3% were exposed to secondhand smoke in their home and 33.7% allowed smoking by visitors. Vietnamese had the significantly highest rates of smoking in the home (44.9%), followed by Cambodians (43.8%), Koreans (42.0%), and Chinese (29.7%). The independent variables that predicted smoking in the home were living in the United States five or fewer years, less acculturation, being female, being foreign born, having a family size of four or more, being Korean, Vietnamese, or Cambodian, and being smokers. The same variables predicted allowing visitors to smoke in the home, excluding being female. Protective factors included being more educated, being older, and having children under 18 at home.

Access to Hepatitis B Vaccination among Korean American Children in Immigrant Families

Abstract: This study examined social determinants affecting successful completion of the hepatitis B vaccination protocol among Korean American children in immigrant families. The effects of family characteristics, social support from support network, barriers to immunizations, and health beliefs concerning hepatitis B vaccination were examined using logistic regression analysis. Information support concerning parenting and child health (adjusted odds ratio (aOR) 2.55, 95% confidence interval (CI) 1.11-7.02) and perception that hepatitis B was a difficult disease from which to recover (aOR 2.11, 95% CI 1.20-3.72) appear to be the most important factors for vaccination compliance after adjusting for family income, mother's education level, and health insurance coverage. The burden of paying for immunizations (aOR 0.50, 95% CI 0.22-0.90) also had an impact on the vaccination status. These findings suggest that identifying the children at risk of undervaccination against hepatitis B may be aided by focusing on these social determinants in addition to provider and sociodemographic characteristics.

Promoting accountability: hospital charity care in California, Washington state, and Texas.

Abstract: Debate as to whether private hospitals meet their charitable obligations is heated. This study examines how alternative state approaches for ensuring hospital accountability to the community affects charitable expenditures and potentially affects access to care for the uninsured. Descriptive and multivariate analyses were used to compare private California hospitals' charity care expenditures with those of hospitals in Texas and Washington state. The key finding from this study is that net of hospital characteristics, market characteristics and community need, Texas hospitals were estimated to provide over 3 times more charity care and Washington hospitals were estimated to provide 66% more charity care than California hospitals. This finding suggests that more prescriptive community benefit or charity care requirements may be necessary to ensure that private hospitals assume a larger role in the care of the uninsured.

The Changing Landscape for the Elimination of Racial/Ethnic Health Status Disparities

Abstract: The elimination of racial/ethnic health status disparities is a compelling national health objective. It was etched in sharp relief by the 1985 report of the U.S. Department of Health and Human Services Secretary's Task Force on Black and Minority Health and considerable attention has been devoted to the problem since that report. But the problem persists, disparities are not fully explained and effective policies to reduce them have been elusive, a situation presenting both opportunities and challenges. Important advances towards reducing racial/ethnic health disparities may be made by better understanding the complex bidirectional relationship between and among the multiple factors, biological and non-biological, influencing morbidity and mortality. The landscape in which these influences are felt is anything but static. In this paper selected components of the landscape that are critical to the elimination of racial/ethnic health status disparities are reviewed. These factors underscore the importance of adopting and maintaining a perspective on health disparities that encompasses a broad array of health determinants.

Reducing unintentional injuries on the nation's highways: a literature review.

Abstract: Death and injury on the nation's highways is a public health crisis, especially for youth and members of selected minority groups. The objective of this paper is to review the literature on behavioral and environmental factors that increase risk for traffic morbidity and mortality in populations at high risk. Each of the following is a risky traffic-related behavior: not wearing seat belts, not using child safety seats, not wearing bicycle or motorcycle helmets, driving after drinking, driving while fatigued or distracted, speeding, running red lights, and aggressive driving. Environmental factors that modify risk include urban sprawl, highway design, public policy, racism and economic inequality. High risk groups include youths, males, pickup truck drivers, urban dwellers, the elderly, African Americans, American Indians, and Alaska Natives. A comprehensive approach must be developed for reducing traffic-related risk of death and injury, especially in high risk populations.

Socioeconomic Differences in Health: How Much Do Health Behaviors and Health Insurance Coverage Account For?

Abstract: As evidence accumulates that both unhealthy behaviors and inadequate access to health care are responsible in part for poor health, there is a tendency to attribute the differences in health status between the poor and the affluent to the higher prevalence of unhealthy behaviors and inadequate access to health care among people of low socioeconomic status (SES). The purpose of this study is to determine quantitatively how much health behaviors and health insurance coverage account for the SES disparity in health. The study employed secondary analysis of data collected through the Kentucky Behavioral Risk Factor Surveillance System for 2000. After adjusting for health behaviors and health insurance coverage, the differences in health among different levels of SES (measured by education and income) remained strong and significant. Health behaviors and health insurance coverage accounted for 10-16% of the socioeconomic differences in health.

Prevalence and Detection of Urinary Incontinence among Older Medicaid Recipients

Abstract: Low-income older adults have higher rates of many medical disorders than those with higher income, but rates of urinary incontinence have not been examined in this population. A random sample of older Medicaid recipients was interviewed (n=910) and medical records examined for the subset with urinary incontinence (n=236). Nursing home residents were randomly selected from Medicaid enrollment files (n=480). Forty-two percent of community residents reported urinary incontinence, with higher rates among women, older respondents, and whites. The medical records for only 22% of community-dwellers contained a diagnosis of urinary incontinence, compared with 77% for nursing home residents. Type of urinary incontinence was specified for 65% of diagnosed community dwellers and 7% of diagnosed nursing home residents. Urinary incontinence rates are high among Medicaid recipients compared with estimates from general population studies, but detection rates are lower for community-dwellers. Physicians may need to do more among low-income older adults in order to detect urinary incontinence.

Are women with self-reported cognitive limitations at risk for underutilization of mammography?

Abstract: Functional limitations (namely, limitations in activities of daily living and instrumental activities of daily living) have previously been demonstrated to exert a negative influence on mammography utilization. This study examines self-reported cognitive limitation in addition to sociodemographic, functional, and other health-related factors to determine their relationship with self-reported mammography use in the previous year. Data from the 1998 National Health Interview Survey was analyzed for 6,053 women, ages 50 years and older. Just over 44% of women with self-reported cognitive impairment (n = 351) reported a mammogram in the previous year, compared with 55% of unimpaired women (n = 5,702). Logistic regression analysis indicates that the presence of a cognitive limitation significantly reduced the likelihood of a mammography in the previous year (p < 0.05) after controlling for other sociodemographic, functional, and health-related factors. Women with self-reported cognitive limitations were 30% less likely than unimpaired women to utilize mammography after controlling for various forms of disability and other factors. Thus, women with cognitive impairments may be at risk for underutilization of mammography and therefore at risk for later-stage breast cancer diagnoses.

Availability of and access to medical services among HIV-infected inmates incarcerated in North Carolina county jails.

Abstract: This study assessed human immunodeficiency virus (HIV)-related services in county jails and staff perceptions of HIV-infected inmates and their care. A statewide telephone questionnaire was administered to detention officers and health care workers providing medical services in North Carolina jails. Eighty-five percent of participating facilities employed one or more on-site medical personnel, including physicians (51%), physician assistants (14%), and nurses (71%). Only 25% of jails tested more than one inmate for HIV per month. In 75% of jails, initial medical screening was performed in a common area. Officers administered medical screening forms at 93% of jails and distributed medications at 81%. Ninety-three percent of officers and 94% of medical staff agreed with this statement: "If an inmate is taking medications in jail, other inmates will know about it." Overall, our data indicate that few North Carolina jail inmates are tested for HIV. Greater protection of confidentiality may improve screening and treatment of HIV-infected inmates.

Pediatric emergency department outreach: solving medical problems or revealing community solutions?

Abstract: Low-acuity (LA) use of emergency departments (EDs) is often viewed as misuse or abuse. We designed a program to help users access services more efficiently. Community health workers (CHWs) functioned as health educators, screeners, and liaisons to care. A participatory curriculum emphasized medical problems. Qualitative ethnographic methods were used for formative evaluation. Ninety families received regular visits from CHWs. Original system-oriented objectives and methods did not fit community needs. Instead, information was gathered regarding service utilization patterns: (1) families mistrusted primary and preventive care, reporting frequent discrimination and humiliation; (2) a primarily biomedical prioritization did not match families' need hierarchies; (3) complex demands of poverty made other uses of the system challenging; (4) primary care services were frequently avoided; and (5) the ED was often preferred. Intangible psychosocial factors and practical complexities of poverty were powerful promoters of LA visits. Families were creative strategists, viewing LA visits as rational use, not misuse, of a challenging system.

Collaborative/Participatory research.

Abstract: Collaborative (or, participatory) research involves a working relationship between at least one academic institution's research unit and one community-based organization. The community-based organizations of interest are those from and representing underserved communities. Barriers to collaboration, approaches to overcoming such barriers, and principles for the maintenance of good collaborative research relations are given. Representatives of the underserved and academic research units tend to interact in a collaborative/participatory relationship by means of formal committees. How the degrees of power of the underserved on such committees might be understood is discussed in terms of a model from Arnstein's 1971 article and the value of participation for the underserved is discussed.

Perinatal health service use by women released from jail.

Abstract: Few studies have examined health care access for the growing population of pregnant women who cycle in and out of urban jails. The present study compared use of Medicaid-funded perinatal services for births to women who were in jail during pregnancy and births to women who had been in jail, but not while pregnant. Jail contact during pregnancy increased the likelihood women would receive prenatal care (odds ratio [OR] = 5.95; 95% confidence interval [CI] 2.18-16.23) and maternity support services (OR = 1.80; 95% CI 1.12-2.88), but was associated with fewer total prenatal and support visits. Jail contact during a previous pregnancy was associated with fewer prenatal care visits, more support service visits, and longer time receiving case management. Jail settings can become a place of coordination between public health and criminal justice professionals to ensure that pregnant women receive essential services following release. Service coordination may increase women's engagement in health services during future pregnancies, with or without subsequent incarceration.

Do Medical Out-of-Pocket Expenses Thrust Families into Poverty?

Abstract: This paper estimates the impact of medical out-of-pocket expenses on families' well-being using the Survey of Income and Program Participation. Medical out-of-pocket expenses include the out-of-pocket costs from medical services and the family's share of health insurance premiums. Demographic characteristics, insurance status, and medical usage of the family are analyzed to determine which characteristics are most likely to impoverish a family. Families impoverished because of medical out-of-pocket expenses are far more likely to have older heads of the family, at least one family member in poor health, or some adults without health insurance. Families without at least one person who worked full time for the entire year were also likely to be impoverished. However, children in the family had little effect on the probability that the family became impoverished. This odd result is probably due to the high correlation between parental health insurance coverage and the health insurance coverage of their children.

Neighborhood Poverty, Mortality Rates, and Excess Deaths Among African Americans: Philadelphia 1999-2001

Abstract: We used vital statistics and census data to determine whether mortality rates in Philadelphia were associated with neighborhood poverty, and to what extent excess mortality among African Americans was associated with neighborhood poverty. Gender-specific, age-adjusted mortality rates for 1999-2001 were strongly associated with neighborhood poverty among both women and men overall, and among both African Americans and non-Hispanic whites. The actual number of deaths among African Americans was 5,305 higher than it would have been if African Americans had had the same gender- and age-specific mortality rates as the average for non-Hispanic whites in Philadelphia, and 1,944 higher than if African Americans had had the same gender- and age-specific rates as non-Hispanic whites in the same neighborhood poverty categories. The excess mortality associated with neighborhood poverty and the socioeconomic factors that force large numbers of African Americans into poverty and high-poverty neighborhoods appear to be major factors in excess mortality among African Americans.

Building an academic-community partnership for increasing representation of minorities in the health professions.

Abstract: We evaluated collaboration among academic and community partners in a program to recruit African American youth into the health professions. Six institutions of higher education, an urban school system, two community organizations, and two private enterprises became partners to create a health career pipeline for this population. The pipeline consisted of 14 subprograms designed to enrich academic science curricula, stimulate the interest of students in health careers, and facilitate entry into professional schools and other graduate-level educational programs. Subprogram directors completed questionnaires regarding a sense of common mission/vision and coordination/collaboration three times during the 3-year project. The partners strongly shared a common mission and vision throughout the duration of the program, although there was some weakening in the last phase. Subprogram directors initially viewed coordination/collaboration as weak, but by midway through the project period viewed it as stronger. Feared loss of autonomy was foremost among several factors that threatened collaboration among the partners. Collaboration was improved largely through a process of building trust among the partners.

Provision of on-site medical care to patients with hepatitis C in drug treatment units.

Abstract: Substance abusers are at high risk for hepatitis C (HCV) infection and also constitute a group that is medically underserved and hard to reach. We conducted a nationwide survey with 445 randomly selected drug treatment units in the United States to determine unit and patient characteristics associated with the provision of on-site medical services for HCV-infected drug users. Eighty-four percent of the 322 units that estimated having at least one HCV-infected patient reported that they provided patients with HCV-related medical care. Drug treatment units were more likely to provide at least some of this care on site if they were residential, part of a network, or affiliated with a hospital; had medical staff; and required that their patients undergo a medical examination before entering treatment. Some organizational factors appear to influence the provision of on-site medical services to HCV-positive patients in drug treatment units. Further research on the role of such factors could inform the development of effective models of care for patients with hepatitis C in drug treatment organizations.