Integrating Sexual Health as a Vital Sign for Improved Patient Health and Patient Engagement

Transcription

1 Integrating Sexual Health as a Vital Sign for Improved Patient Health and Patient Engagement National Health Care for the Homeless Council Midwest Regional Health and Housing Meeting Chicago July 15,2013

2 Routine HIV Screening at Piedmont Health Services Evette Patterson, BSN, Clinical Services Director

3 Piedmont Health Services Brian Toomey, CEO Abigail DeVries, MD, Medical Director PHS is located in Central/Piedmont North Carolina PHS was established in March 1970 Joint Commission Accredited We provide medical, dental, pharmacy, case management, WIC and nutrilon services Comprised of 7 medical centers and a PACE site

4 Piedmont Health Services Our mission is to improve the health and well being of the community by providing high quality, affordable and comprehensive health care. Our vision is a healthy community in which all people have Lmely access to quality health care.

5 Piedmont Health Services n 40,000 users in 2012 n 112,000 Medical Encounters n 15,359 Dental Encounters n 59% Uninsured n 98% At or below 200% federal poverty level n 41% Prefer care in language other than English

6 Carrboro CHC Corporate Office Charles Drew CHC

7 CDC Recommendation for HIV Screening Revised in September 2006 Revised Recommendations for HIV Testing of Adults, Adolescents and Pregnant Women in Health-Care Settings HIV screening for all persons yrs. of age as a part of routine primary care Voluntary Testing Separate informed consent not required Prevention counseling and risk-based assessments not required

8 How Did We Get Started With Routine Testing? Had a system for testing pregnant women In 2007 the CDC funded a pilot project for implementation of routine testing into Primary Care and we were one of the 6 CHCs from North Carolina, South Carolina and Mississippi that agreed to participate We received administrative support for the implementation and free testing supplies

9 HIV Screening Model Front Desk Vitals Area/ HIV Testing Waiting Room Front desk greets patient and verifying insurance and demographics. Clinical area notified. HIV testing information available in waiting room. MA escorts patient to vitals area for height, weight, temperature, and blood pressure and offer rapid HIV testing. Exam Room Escorted to exam room by nursing staff. Provider performs clinical exam and gives results, negative or reactive. Laboratory Check Out If blood work necessary, provider writes an order. Patient carries lab request to the lab for blood draw. Patient proceeds to check out area for scheduling of next visit.

10 What Worked Well Center- wide HIV awareness meelngs prior to implementalon of Rapid TesLng Training of the Rapid TesLng process for front desk, MAs and RNs and providers Simplicity of the test Value added service to the palent of knowing their results during the visit Low literacy posters and pamphlet with simple facts in English and Spanish (this prompted palent to ask us for the test) Partnership with nearby hospital and their willingness to accommodate our palents in a Lmely manner

11 Challenges Large populalon of palents whose primary language is Spanish Staff turnover/staff vacancies Overcoming the MA s reluctance to offer the test roulne care Developing a workflow that worked best for the praclce and respected confidenlality Dealing with false posilve tests MoLvaLon to conlnue performing the test

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13 1 year. What do we do now?

14 PHS Desire to continue routine testing Had created a system for data collection Had proven that we could successfully implement a program State Willing to provide Free Test in exchange for data

15 Does This Relationship Work? PHS receives free rapid testing supplies from the state of North Carolina through grant funding provided by the CDC for HIV testing in healthcare settings. In exchange for free supplies we provide the state with data on a monthly basis regarding the patients that are tested. There was an offer for the state to do our confirmatory testing but results take about 2 weeks (This does not work for our organization.) Confirmatory testing is billed to patient's payer source or to PHS.

16 Data Exchange Reported data includes patient s age gender reason for visit results testing history ( Have you ever been tested before? ) confirmatory test result for reactive test

17 Number Of Rapid Test Performed Total Test Performed Reactive Test Confirmed Positive Linked To Care ,

18 5 Keys to Success s Know What Data You Want to Collect and Build Your Systems Around That s Training s Why test (staff buy in) s Performing test (initial and ongoing) s Providers s Anticipate the False Reactives s Prepare the staff s Have a plan of action for the reactive s Establish Relationships s How will you handle newly diagnosed patients s Identify your internal and external resources s Keep Staff Motivated

19 Partnerships/Relationships State DIS (Disease Intervention Specialist) could be valuable in the follow up and informing of confirmed test. Partnerships with Infectious Disease Clinics in your area are important when patients are confirmed to be HIV positive.

20 Where Do We Go From Here? PHS has received a grant from UNC Hospitals (large teaching hospital who is Ryan White funded) to provide a medical home to 10 stable HIV positive patients who have established care at the Infectious Disease Clinic with them available for consultation

21 Internal and External Partnerships and Relationships are Essential to Success!