Improving HIV & Hep C Screening and Testing Results. Shikata Mudakha M.D., Physician Lead Armando Rojas, Patient Coordinator
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1 Improving HIV & Hep C Screening and Testing Results Shikata Mudakha M.D., Physician Lead Armando Rojas, Patient Coordinator
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3 Dining Room Clinic Clothing Program Father Alfred Center Tech Lab Social Work Center
4 Tenderloin Neighborhood Overview San Francisco s Tenderloin neighborhood has the highest concentration of poverty in the city SFDPH Stats New HIV Dx 189/Tenderloin v. 83/San Francisco, in ER Visits Self Inflicted Injury 35/Tenderloin v. 10/San Francisco per 10,00 adults/year Alcohol Abuse 227/Tenderloin v. 58/San Francisco per 10,000 adults/year Drug Poisoning 120/Tenderloin v. 23/San Francisco per 10,000 adults/year SAMC Patient Panel ~5000 Patients 75% homeless/marginally housed 64% below FPL 36% % FPL Race 56% Caucasian (including Hispanic) 33% African American 11% Asian 55% of patients best served in a language other than English
5 STAFF Clinic Director Primary Care Physicians 4 Per Diem N.P. 3 Specialty M.D. 3 Behavioral Health Team/CSW 8 Front Office 5 Medical Assistants 7 Support Staff/Volunteers 7
6 Previous MA Work Flows Paper Prep for Pedi/Adult Sessions Little attention to recent HIV/Hep Serology Papers shred by EOBD resulting in duplicate work for rescheduled apts
7 Current CPS12 Adult Chart Prep
8 Current CPS12 Pedi Chart Prep
9 CPS 12 Updates Adult Previsit Review / Pediatric Previsit Review
10 GILEAD Improving Best Practices Initiative
11 May 15, 2017 Application for GILEAD funding to increase the number of HIV/HCV screening tests by screening existing patients 13+ HIV and 18+HCV Proposal Included allocating funds towards new-patient outreach at homeless encampments, homeless shelters, and home visits to SRO residents
12 Project Coordinator Supplies Transportation
13 Jackie Mojigo, MA Added HIV/HepC Tracking Templates Outreach Flowsheet Updates Began Care Alerts
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16 Monthly Estimates
17 Quarterly Reporting Template Instructions HIV_HCV_HBV_Summary HIV_HCV_HBV_Positives Validation_Summary
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20 CPS12 Aids in Outreach/Linking Patients to Care Phone Note Registration Alerts Including areas most frequently visited in Pt Registration Patient Notes Box
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22 HIV/Hep C Screening HIV Hep C
23 HIV & Hep C Screening Tools
24 MA Certificates come with limited phlebotomy Cheat Sheet created to reduce RN requests/missed testing opportunities
25 Reached out to local DPH for HIV Testing/Counseling Training 1. Syringe Exchange Services 2. Oral Sex 3. STIs 4. Partner Services 5. Nightline 6. Drugs/Injection 7. Fentanyl/Narcan 8. No Doubt instillment 9. The know it all 10. Client w/very little risk 11. Homelessness/Mental Health 12. Drivers of HIV 13. Sexual Assault 14. The non talker 15. Client substance abuse 16. Partner Violence 17. The helicopter partner 18. Clients with OCD 19. PrEP/PEP
26 Medical Assistant Testimonials I was worried the [HIV Testing/Counseling] training was going to be all talk because I don t like to talk but I realized a good counseling session is more client expressing themselves than me Jackie We really didn t pay attention to this before in our chart prep but it s good we can expand our basic knowledge of HepC/HIV for the benefit of the patient Maria Having the blood draw cheat sheet makes me more comfortable in trying my own blood draws - Veronica I look for ways to encourage growth within clinic. This HIV testing counseling training allows for MAs to not feel like they need to go somewhere else to gain more knowledge - Zeke
27 Rapid Testing -Training MA/Volunteers -Proper storage/temp logs -Storing/Running Controls -Calibrated Thermometers -Network with local agencies to start an e- mail thread for soon to expire Rapid Tests
28 Supplies Price Alere Determine HIV ½ Ag/Ab Combo $ Alere Determine HIV ½ Ag/Ab Combo - Controls $51.19 OraQuick HCV Rapid Ab Test $ OraQuick HCV Rapid Ab Test - Controls $43.49 Traceable Thermometer / Clock / Humidity Monitor $58.14 Tax Total Local State Tax $1, minimum
29
30 Patient Tracking Systems
31 i2i Tracking Report
32 AZARA DRVS Report
33 Patient Challenges Limited Mobility Language Barriers Difficulty Navigating Specialty Appointments Frequent Cell Phone Deactivation Lost to Follow-Up
34 Patient Navigators -encouraged to volunteer on a monthly basis -limited to no medical certification allows for less clinic interruption -signed up for deescalation trainings and county hospital tours
35 Summary & Contacts - Centricity 12 Updates & Data Storage/Patient Alerts - Targeted efforts through MA workflow - Testing/Supplies Funding - Local DPH HIV/HepC Testing & Counseling Trainings - Patient Tracking Systems - Networking within your community programs - Using local transportation St. Anthony s Medical Clinic in San Francisco Armando Rojas E: arojas@stanthonysf.org GILEAD Myra Ozaeta E: myra.ozaeta@gilead.com San Francisco Department of Public Health Theresa Ick E: theresa.ick@sfdph.org Thomas Knoble E: thomas.knoble@sfdph.org CareMessage Cecilia M. E: ccorral@caremessage.org
36 Q & A
37 End
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