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Retaining New Patients in HIV Care Cooper EIP. November 14, 2013. For Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368#. Welcome & Introductions. Welcome & Introductions, 5min Cooper EIP DiscussesRetaining New Patients in HIV Care, 30min Panel Discussion, 20min - PowerPoint PPT Presentation
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Retaining New Patients in HIV Care
Cooper EIP
November 14, 2013
For Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368#
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Welcome & Introductions Welcome & Introductions, 5min Cooper EIP DiscussesRetaining
New Patients in HIV Care, 30min Panel Discussion, 20min Updates, Reminders & Evaluation, 5min
In the chat room, Enter your: 1. name, 2. agency, 3. city/state, and 4. professional role at agency
Michael Hager, MPH MA NQC Manager,in+care Campaign ManagerNew York, NY
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For more information: www.incarecampaign.org
This Partners in+care webinar is offered as part of the in+care Campaign. The in+care Campaign is a national effort to improve retention in HIV care. Webinars are one of many Partners in+care activities designed to engage people living with HIV/AIDS and their allies in the in+care Campaign.
Welcome & Overview
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This is a “public event.” If you have confidentiality concerns:
Your names appear on-line in the list of webinar registrants -consider just listening to the audio or to viewing the webinar at a later time, after it is posted at www.incarecampaign.org
All webinars are recorded - do not use identifying information when asking questions
Participation Guidelines
For Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368#
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Actively participate and write your questions into the chat area during the presentation; we will also have a “pop up” question exercise, and will pause for conversation during the webinar
Do not put us on hold Mute your line if you are not speaking (press
*6, to unmute your line press #6) The slides and recording of this and other
Partners in+care webinars are available for playback and group presentations at www.incarecampaign.org – “Events” tabFor Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368#
Participation Guidelines
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Visit www.incarecampaign.org
Pop-up QuestionWhat share of your total patient
population was new to your clinic in the last year? (best estimate is ok!)
More than 50%Between 25% and 50%Between 10% and 25%
Less than 10%I have no idea
I do not work in a setting that provides direct patient care
Retaining New HIV Patients
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Visit www.incarecampaign.org
Pop-up QuestionDo you feel your organization is better or worse at retaining new patients in comparison with all
ongoing patients in general?We are better at retaining new patientsWe are worse at retaining new patients
We retain both new and ongoing patients with about the same level of success
I have no ideaI do not work in a setting that provides direct patient care
Retaining New HIV Patients
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Retaining New Patients in HIV Care
Pamela A Gorman, R.N., ACRN Administrative DirectorEarly Intervention Program and Infectious DiseasesCooper University [email protected]
Lucy Suokhrie, RN-BC; BSN; MSHCA
Clinical NavigatorEarly Intervention Program and Infectious DiseasesCooper University Hospital856.968.7261John-LaSalle A. KingExecutive CAB MemberSouth Jersey Community Advisory [email protected]
Pamela Gorman, R.N., ACRNAdministrative Director, EIP and Infectious [email protected]
Cooper Early Intervention Program:
A Community Collaborative Approach for HIV Testing and Linkage to Care
Meeting the challenge: What challenge?
The integration of HIV Care and Treatment Programs with Prevention Programs
How? Started with an invitation to a meeting
including Ryan White programs and Community Based HIV Prevention Programs
The purpose The formal establishment of a Community
Collaborative Committee
Collaborative Partners Agree to:
Ryan White Medical Care Programs
Community Based Organizations
Primary agencies for linking new and lost to care HIV infected persons with medical care services
Immediate access to care within 24-72 hours
Engage patient in Clinical Navigator services
Confirm HIV infection (if needed)
Perform HIV rapid testing services
Identify new and or lost to care HIV infected persons
Immediately refer person to Ryan White Program or designated HIV Care Provider
Contact Clinical Navigator to assure linkage with medical care
During the first year
Program Directors commit to the collaboration
Officially name the committee
Develop an aim statement
Started with monthly meetings
Establish a Memorandum of Agreement as a “living” document
Provide a venue and system for identifying and addressing community concerns
SAFEPAT Strategic Alignment For Effective Care And Treatment
Aim Statement
“The collaboration of prevention and treatment services to assure coordinated
healthcare practices and a healthy community”.
What is the purpose of the SAFEPAT Memorandum of Agreement (MOA)?
A formal commitment by Agency Directors to participate and contribute to the collaborative through the establishment and execution of a
“living” document
The MOA Identifies:
Participating Agencies
Individual AgencyResource PersonContact InformationAgency ServicesHours of Operation
Agencies are added to the document each year – currently 9 Directors have contributed and signed the MOA
General Agreement
Host SAFEPAT Committee Meetings once per year.
Encourage and support client participation on the Southern New Jersey Community Advisory Board.
Host one CAB meeting per year.
Arrange transportation for clients to attend CAB meetings (per agency’s transportation policy).
Each Agency will:
Committee Successes Established a community collaboration
agreement in the form of an MOA (started with 5 agencies and now have 9)
Committee membership/participants increased, averages 15-20 participants
CAB membership/participants increased
Developed standardized forms and processes for linking patients to care and other services
Future Works Addressing concerns related to the
rising numbers of young MSM newly identified infections (18-25 y/o)
Establish a community quality improvement project to improve referral and linkage to prevention education programs that focus on this high risk population
John LaSalle KingChair, Southern New Jersey Community Advisory [email protected]
Southern New Jersey Community Advisory Board (SNJCAB)
The purpose of CAB is to provide a partnership between the Community & Service Providers regarding HIV related medical care, support services, and research activities.
Southern New Jersey Community Advisory Board (SNJCAB)
Members are committed to becoming educated about changes and advances in the treatment and prevention of HIV infection.
In addition, members contribute to providing feedback that drive those changes that impact those services in prevention and care.
The CAB works to promote the physical and mental health of all ages and cultures affected or infected with HIV.
The ultimate goal is to ensure that HIV related services and research operate to reduce the impact and stigma of the HIV epidemic.
Southern New Jersey Community Advisory Board (SNJCAB)
What does this mean to the Consumer?
Empowers the consumer to take charge and have a voice.
Provides the venue for consumers to describe their perception of best practice models (prevention & medical care).
Provides a mechanism to give back/pay it forward to the community.
What is Clinical Navigation?
Clinical Navigation is an intervention that helps in linkage to care and retention in care through guidance and support
Clinical Navigation aims to improve outcome by engaging patient’s in their medical care by addressing barriers to care
Goals of Navigation
• Immediate access to Health Care Provider and services
• Provide information and treatment options
• Re-engagement of lost to care patients
• Retention in Care
• Treatment adherence and prevention
• Partner testing services
Role of the Navigator The newly diagnosed HIV patient
experiences significant anxiety and stress.
For most people this overwhelming experience can become incapacitating
The navigator is able to reduce the anxiety through communication, support, education and identification of service resources and facilitation
Research Findings
Newly diagnosed patients who are receiving HIV care, mortality is twice as high for those who miss a clinic visit within the first year of diagnosis.
(Mugavero, Lin, Willig, et al., 2002)
Study done on ‘Failure to establish HIV care’ showed that longer waiting time from call to schedule a new patient visit to the appointment date was associated with failure to establish care(Mugavero, Lin, Allison, et al.2007)
Non-adherence with appointments has been associated with failure to reach undetectable levels, clinical disease progression(including AIDS-defining illnesses), and death ( Giordano et al.,2007)
Navigation helps patients by
Providing comprehensive and easy-to access services
Decreasing structural barriers at clinics
Creating an environment to decrease anxiety and help patient navigate the system with ease
Providing basic HIV education
Teaching patients the skills that will help them stay in care
Use of effective behavioral interventions
Clear- Choosing Life Empowerment Action Results
ARTAS- Anti Retroviral Treatment and Access to Services
Barriers Lack of time
Unable to commit to these sessions
Other socio-economic issues
Mental Illness
Lack of Knowledge about the disease
Benefits of Navigator With the Navigator on site, patients are
seen within the same day or next business day
Patient has a go to person to assist them
Patients are educated on their care, what to expect and next steps
Conclusion The ultimate goal of navigation is
removal of potential barriers such as communication, psycho-social dilemmas, fiscal, and any other logistics which can disrupt the continuum of care. The success of the concept is the provision of support and advocacy from diagnosis to survivorship by means of education, guidance and reassurance
References Farrisi,Daniele; Dietz Natalie,(2013) Patient Navigation is a
client-centered approach that helps to engage people in HIV care. HIV Clinician, winter 2013,Vol. 25 No. 1, 1-3
Giordano,T.P.,Gifford,A.L., White, A.C., Suarez-Almazor, M.E.Rageneck, L., Hartman, C, Morgan, R.O. (2007) Retention in care : A challenge to survival with HIV infection. Clinical Infectious Diseases, 44,1493-1499
Mugavero,M.J.,Lin,H.Y., Allison,J.J., Giordano, T.P.,Raper,J.L., Saag,M.S.(2009). Racial disparities in HIV virologic failure: Do missed visits matter? Journal of Acquired immune Deficiency Syndrome, 50(1),100-108
Mugavero,M.J.,Lin,H.Y.,Willig, J.H.,Chang,P.W.,Marler,m.,. Saag,M.S.(2009).Failure to establish HIV care: characterizing the “no show” phenomenon. Clinical Infectious Diseases,48, 248-256
Wilcox, B., & Bruce, S.D. (2010) Patient Navigation: A “win-win” for all involved. Oncology Nursing forum, 37(1),21-25
Cooper University Hospital Early Intervention Program (EIP)Contact information:
Pamela Gorman, R.N., ACRNAdministrative Director, EIP and Infectious [email protected]
Lucy Suokhrie, RN-BC, BSN, MSHCAClinical Navigator, [email protected]
John LaSalle KingChair, Southern New Jersey Community Advisory [email protected]
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Retaining New Patients in HIV Care
Pamela A Gorman, R.N., ACRN Administrative DirectorEarly Intervention Program and Infectious DiseasesCooper University [email protected]
Lucy Suokhrie, RN-BC; BSN; MSHCA
Clinical NavigatorEarly Intervention Program and Infectious DiseasesCooper University Hospital856.968.7261John-LaSalle A. KingExecutive CAB MemberSouth Jersey Community Advisory [email protected]
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Let us know your experiences in the chat room!
What interventions are used to keep patients in care?
What about specific interventions for newly diagnosed?
Retaining New Patients in HIV Care
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Let us know your experiences in the chat room!
How does the referral process for linkage to care actually
work?
Retaining New Patients in HIV Care
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Visit www.incarecampaign.org
Pop-up Question
More likely than before I watched this programNo more or less likely than before I watched this
programLess likely than before I watched this program
I do not work in a setting that provides direct patient care
Retaining New Patients
How likely are you to reevaluate your process
of retaining new patients to care as a
result of this webinar?
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Campaign Headquarters:National Quality Center (NQC)90 Church Street, 13th floorNew York, NY 10007Phone 212-417-4730
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