9:00am-10:00am: Integrating HIV in Primary Care: From Trends to Training Speakers: Brian Hujdich, HealthHIV & Stephen Perez, HealthHIV

Transcription

1 9:00am-10:00am: Integrating HIV in Primary Care: From Trends to Training Speakers: Brian Hujdich, HealthHIV & Stephen Perez, HealthHIV 10:00am-11:00am: Integrating HIV In Primary Care: The NHAS and HIV Care Team Model of Ryan White Speakers: Ronald D. Wilcox, MD, Delta Region AIDS Education & Training Center 11:00am-11:15am BREAK 11:15am-12:00pm: Panel Discussion: HIV Integration into Primary Care: Evolving toward a new reality Moderator: Brian Hujdich, HealthHIV, Executive Director Panelists: Tenya Fann, MD, MPH CO-Medical Director, Community Health Center of Buffalo, Stephen Perez, NP Clinical Specialist HealthHIV Nurse Practitioner, Inova Juniper Program, Kathy Brown, MD, FACP, AAHIVS HIV Medical Director, Country Doctor Community Health Center

2 HIV Integration into Primary Care: Evolving Toward a New Reality. Panel Discussion March 21, 2013

3 Moderator: Brian Hujdich Executive Director, HealthHIV No Relevant Disclosures Panelists: Kathy Brown MD FACP AAHIVS HIV Medical Director, Country Doctor Community Health Center Seattle, Washington Disclosure: INSERT Teniade Fann, MD, MPH Medical Director, Community Health Center of Buffalo Buffalo, New York Disclosure: Consultant for Marketing Information Gilead Sciences Stephen Perez, NP, AAHIVS HIV Clinical Specialist, HealthHIV Nurse Practitioner, Inova Juniper Program/Transitional Care Services Arlington, Virginia Disclosure: Advisory Board for Scientific Information Gilead Sciences

4 Identify barriers to integration of HIV into primary care Describe the experiences of providers as they try to integrate HIV into primary care Discuss the implications for providers after HIV is integrated into primary care Discuss concerns of providers who may be beginning to integrate HIV into primary care

5 In 2006, the CDC expanded screening recommendations to all persons aged USPSTF recently submitted draft recommendations for all adolescents and adults ages More funding for testing and more diagnoses made (many times in high volume settings i.e. emergency departments) Patients with HIV are also moving from urban to rural areas where specialty care access may be limited Trained HIV specialists (MD, PCPs, ID, Midlevel Providers) are not readily available in many areas (what is a specialist?) 1 Institute of Medicine (2011). HIV Screening and Access to Care: Health Care System Capacity For Increasing HIV Testing and Provision of Care. Accessed October 31, 2012 from 2 USPSTF Screening for HIV: U.S. Preventive Services Task Force Recommendation Statement DRAFT (2012) Accesed 11/22/12 from

6 Patients are presenting with high complexity given longer survival times, medical comorbidities, and late diagnosis Now a chronic care issue a Specialists are confronted with complex co-morbidities and PCPs are confronted with specialty ID issues HIV-positive patients often need other specialty involvement (i.e. GI, Surgery, Endocrine, Pulmonary, Colo-rectal etc )

7 Factors Supporting HIV Integration in CHCs External Factors HIV prevalence Need for more Providers Funding Federal, State & Local prioritization Mentorship and technical assistance support Internal Factors Motivated Leadership (Board & CEO) Motivated Clinicians HIV experienced Clinicians Desire to provide comprehensive HIV Care

8 Restricting Lack of Providers Geography Competition between sites Lack of funding Inadequate access to mentorship and technical assistance

9 Panelists remarks

10 KATHY BROWN MD FACP AAHIVS HIV MEDICAL DIRECTOR COUNTRY DOCTOR COMMUNITY HEALTH CENTER SEATTLE, WA

11 TENIADE FANN, MD, MPH MEDICAL DIRECTOR COMMUNITY HEALTH CENTER OF BUFFALO BUFFALO, NEW YORK

12 STEPHEN PEREZ, NP, AAHIVS HIV CLINICAL SPECIALIST HEALTHHIV NURSE PRACTITIONER INOVA HEALTH SYSTEM ARLINGTON, VA

13 Questions Regarding Barriers to Implementing HIV into Primary Care WHAT DO YOU SEE AS A LARGEST BARRIER TO INTEGRATING HIV CARE INTO PRIMARY CARE? THIS COULD BE EITHER IN YOUR OWN PERSONAL EXPERIENCE, BUT ALSO WHAT YOU HAVE OBSERVED IN OTHER SETTINGS?

14 Questions Regarding Barriers to Implementing HIV into Primary Care Have you found that traditionally, provider related barriers (stigma, lack of training, discomfort around the topic) or systems barriers (cost, funding streams, low prevalence) are more often responsible for the lack of integration of HIV into primary care?

15 Questions Regarding Barriers to Implementing HIV into Primary Care WHAT DO YOU SEE AS A MAJOR MEANS OF OVERCOMING THESE BARRIERS?

16 Questions Regarding Barriers to Implementing HIV into Primary Care HAS ANYONE EXPERIENCED RESISTANCE TO PRIMARY CARE PROVIDERS, PARTICULARLY MID-LEVEL PROVIDERS, TAKING ON WHAT HAS CONVENTIONALLY BEEN THOUGHT OF AS THE EXCLUSIVE ARENA OF HIV SPECIALISTS/INFECTIOUS DISEASE PROVIDERS?

17 Questions about factors influencing HIV Integration in Primary Care HOW DO YOU ENVISION THE ACA PLAYING A ROLE IN YOUR PRACTICE IN TERMS OF THE INTERSECTION OF HIV AND PRIMARY CARE?

18 Questions about factors influencing HIV Integration in Primary Care WHAT OTHER POLICY OR SYSTEMS CHANGES HAVE INFLUENCED HIV INTEGRATION INTO PRIMARY CARE FOR YOUR PRACTICE AND THOSE IN YOUR REGIONS?

19 Questions about factors influencing HIV Integration in Primary Care HAS ANYONE HAD ANY EXPERIENCE WITH PCMH AND HAS THAT OR WILL IT INFLUENCE THE DELIVERY OF HIV PRIMARY CARE SERVICES?

20 Questions about HIV Primary Care delivery HOW DO YOU MANAGE WITH THE MEDICAL AND PSYCHOSOCIAL COMPLEXITIES OF MANAGING SOMEONE WITH HIV AND MULTIPLE CO-MORBIDITIES IN THE CONTEXT OF A PRIMARY CARE VISIT?

21 Questions about HIV Primary Care delivery FROM AN ADMINISTRATIVE PERSPECTIVE, HOW DO YOU OFFER SUPPORT TO YOUR PROVIDERS WHO ARE ALREADY UNDER A TIME CRUNCH? HOW DO YOU PROVIDE THEM WITH THE TOOLS THEY NEED TO PROVIDE EXCELLENT CARE TO PEOPLE LIVING WITH HIV?

22 Questions about HIV Primary Care delivery HAVE THERE BEEN UNANTICIPATED ISSUES OR CONCERNS THAT YOUR PROVIDERS HAD ONCE THEY ACTUALLY STARTED PROVIDING HIV TREATMENT AND CARE?

23 Final Thoughts If you were stopped in the hall by a colleague who asked you for a curbside consultation on how to integrate HIV into their own primary care practice, what basic advise would you give them?

24 HEALTHHIV 2000 S STREET NW WASHINGTON, DC