Ensure access to and compliance with treatment for low-income uninsured Virginia residents living with HIV/AIDS

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1 Public Health/ CHSB Lilibeth Grandas x1211 Sharron Martin x1239 Program Purpose Program Information Ensure access to and compliance with treatment for low-income uninsured Virginia residents living with HIV/AIDS The program is federally funded through the Ryan White (RW) Program and administered through the Virginia Department of Health (VDH). PHD administers the Direct ADAP component. o VDH performs eligibility for every ADAP applicant. Criteria includes: Virginia residency, HIV positive, under medical care, CD4* and viral load** lab results within the previous six months, not eligible for Medicaid, and income below 40 of the Federal Poverty Level (FPL). Patients must present CD4 counts and viral loads to VDH every six months to remain eligible, and can access medical care at organizations that receive Ryan White funding. o Direct ADAP provides free medications to eligible uninsured individuals. Direct ADAP treating physicians submit medication orders to the VDH Central Pharmacy, which sends a 30 day medication supply to the Public Health Division or an alternate delivery site for patient pick up. The role of the ADAP staff is to: o Inventory, verify, and store medications by patient name. o Send medication requests to VDH on a monthly basis for each patient. o When a refill is needed, VDH initiates contact with the prescribing physician. If unsuccessful, ADAP staff follows up with the physician. o Schedule patient appointments for medication pick up, and contact patients to remind them of their appointment the week prior. Contact patients within one week if they miss their pick up appointment. o Clinic hours are offered weekly, and a nurse is available to answer questions about medications and side effects. Patients can pick up medications outside of clinic hours with the Public Health Division s Nurse of the Day. As of January 2015, 69 clients were enrolled in Direct ADAP. are discharged if they gain insurance, move out of the area, or are closed after 6 months of inactivity as mandated by VDH. Partners: Inova Juniper Program, VDH, Whitman Walker Clinic and private medical providers *CD4: Measures immune system strength **Viral Load: Measures the amount of HIV virus in the blood. PM1: How much did we do? Staff ADAP Total = 1.3 FTEs 0.25 FTE Nursing Supervisor 0.25 FTE Nursing Coordinator 0.4 FTE Public Health Nurse 0.4 FTE Pharmacy Technician Page 1

2 Customers and Service Direct ADAP FY 2013 FY Visits In FY 2012 there was a waitlist for Direct ADAP due to funding constraints. In FY 2013, VDH received a grant that allowed them to enroll everyone on the waitlist in Direct ADAP. At the same time, VDH started enrolling clients in a pre-existing condition health insurance plan. VDH eliminated that program in FY 2014 due to Affordable Care Act (ACA) implementation, and enrolled those clients in Direct ADAP until they could be enrolled in ACA plans. PM2: How well did we do it? 2.1 Client satisfaction survey 2.2 Clinical documentation of VDH eligibility, medication pick-up, and lab results PM3: Is anyone better off? 3.1 Patients who pick up their medications before they run out 3.2 HIV positive individuals whose HIV viral load is undetectable Page 2

3 Measure 2.1 Client satisfaction survey 6% 8% 8% 4% 9% 16% 16% 94% 92% 92% 96% 91% 84% 84% FY /32 37/37 ADAP Clinic Client Satisfaction Survey Overall Satisfaction Goal = 95% Agree or Strongly Agree FY /53 FY /32 Information was clear Strongly Agree Agree Disagree Strongly Disagree 37/37 ADAP Client Satisfaction Survey: Services Provided in an Easily Understood Language FY /53 FY /32 Goal = 37/37 Clinic services were offered in a language I could easily understand. Yes No Survey conducted once a year, capturing all clients served over a two-week period, using a paper survey in English and Spanish. Survey will be conducted twice a year starting in. response rate was 95%. Satisfaction was high on the following areas: receiving services in a language they could easily understand, receiving information that was clear, being treated professionally by staff and overall satisfaction. Stay the course. Satisfaction in these three areas will continue to meet or exceed goal of 95% agreeing or strongly agreeing. Page 3

4 Measure 2.2 Clinical documentation of VDH eligibility, pick-up log, and lab results Audit of Chart Documentation 5% 5% 54% 54% Goal = 95% 35% 35% 46% 46% 95% 95% 65% 65% Q4 17/37 Charts Q4 35/37 Charts Q4 24/37 Charts Current Eligibility Pick-up log Lab Results Correct Documentation Missing Documentation A sample of 5 of active client charts were reviewed in Q4 to ensure compliance with VDH documentation requirements, specifically current documentation of client eligibility, completeness of the required medication pick up log, and documentation of viral load. CD4 results will be included in future audits. Each chart will be audited twice a year in future years. 27% of clients had all documentation correct. o 46% of clients had current (within 6 months) documentation of client eligibility o 95% of clients had complete medication pick up logs o 65% of clients had current (within 6 months) documentation of viral load For the pick-up log, which is the program s responsibility, the percentage complete was very high at 95%; however, the data obtained from VDH on eligibility and lab results was not up to date, which impacted overall compliance. Work with the Virginia Department of Health to improve timeliness of eligibility and lab results Contact VDH to find out the source of most current information is on eligibility and lab values. If the state does not have it, then obtain a release from the clients to request the information from their private physician. The percentage of clients with correct documentation will remain about the same in FY Page 4

5 Measure 3.1 Patients who pick up their medications before they run out When clients pick up medications, they are asked if they depleted their medication before picking up the new medication and why. Two new procedure codes allow program staff to indicate on the encounter if the medication was picked up before the client ran out of previous medication. The procedure codes are entered into WebVision by Admin staff when they enter the encounter. Reports will be run in WebVision to calculate the percent of clients that picked up their medication before running out. No data available. collection will start in. Page 5

6 Measure 3.2 HIV positive individuals whose HIV viral load is undetectable ADAP clients with an undetectable viral load 22% 22% Goal = 9 78% 78% 56/72 (projected) Undetectable Detectable is submitted every 6 months to VDH by the clients physicians. PHD requests a report of clients viral loads from VDH twice a year. Figures include all clients open as of June 2015 with viral load results within the past 12 months, as results less than 12 months old are still clinically relevant. without recent viral load results are excluded. was available on 72 of the 74 clients. Per CDC, for surveillance purposes, undetectable viral load is 50 copies/ml 78% of our population achieved viral suppression, which is very high compared to the Virginia statistic of 37% and the national statistic of 3. In addition to demographic and geographic factors, ADAP s flexible hours and client education promote medication compliance and contribute to the high viral suppression rate. Research shows that HIV positive patients who are on HIV medications will achieve viral suppression by taking their HIV medications 9 of the time. Many factors play a role in lack of viral suppression such as non-adherence to medications, new HIV diagnosis, and other illnesses. Work with clients who did not achieve viral suppression and their physicians and explore possible reasons why they are not taking the medications or why the medications are not effective. Based on the findings, work with patients and providers to see if there are any barriers we could help reduce. The percent of clients with undetectable HIV viral loads will remain about the same in FY Page 6