BC Centre for Excellence in HIV/AIDS Intensive Preceptorship Program in HIV/AIDS for Family Physicians and Nurse Practitioners Dr. Silvia A. Guillemi Director of Clinical Education, BC Centre for Excellence in HIV/AIDS Clinical Professor, Department of Family Practice, University of British Columbia Page 1
Disclosure Dr. Silvia A. Guillemi Relationships with commercial interests: In the past two years, I have attended advisory board meetings for Gilead Sciences and I have received honoraria for my participation Page 2
Clinical Education Program Team Dr. Helen Kang, PhD Clinical Educator Karah Koleszar Administrative Assistant Amanda Khorsandi Program Coordinator BC CfE Dr. Julio Montaner Director, BC Centre for Excellence in HIV/AIDS Professor and Head, UBC-Division of AIDS Faculty of Medicine, UBC Dr. Rolando Barrios Assistant Medical Director, BC Centre for Excellence in HIV/AIDS Ms Irene Day Director of Operations, BC Centre for Excellence in HIV/AIDS Page 3
HAART stops HIV replication HIV load falls to undetectable levels in plasma as well as in sexual fluids Sharp reduction in HIV transmission Treatment as Prevention(TasP) Page 4
New HIV Diagnoses and HAART Use Testing Rates in BC Page 5
In 2011, BC-CfE developed the HIV Intensive Preceptorship Training program for primary care providers 2010, Expansion of HIV testing and treatment in BC (TasP initiative) HIV is a chronic disease, as HIV-positive patients are living longer and require longterm care. Historically In BC, family physicians prescribe and monitor antiretroviral therapy. Page 6
Objectives of the BC-CfE HIV Intensive Preceptorship Program Acquire competence and confidence to provide the primary care management of HIV positive patients Assess patients and initiate antiretroviral therapy as appropriate Monitor and identify patients with treatment failures and toxicities Assess HIV-related co-morbidities Provide a comprehensive care plan to HIV positive patients Engage in the organizations and the inter-professional teams Avail themselves of educational programs, supports and resources available through the BC-CfE Page 7
Module 1 Foundations Self-Directed Learning Distance Education 1. Online Course HIV Diagnosis & Management 11 units on topics relevant to primary care in HIV 10-12 hrs, with quiz for each unit to provide learning feedback Receive 10 Mainpro-M1 credits Individually Tailored Learning 2. Learning Objectives After completing online course, trainees individually interviewed by Program Director to establish learning objectives Page 8
Module 2-3 Preselected Participants Distributed Medical Education Interactivity 3. Clinical Placements Clinical placements at inter-disciplinary sites: HIV primary care clinic, HIV treatment clinic, specialist clinics (i.e. metabolic, dermatology, renal), HIV/Urban health inpatient clinic, HIV outpatient pharmacy, Hepatitis C clinic, Women s HIV clinic 4. Lunch-hour Tutorials Intimate learning with HIV experts Opportunity to review online course material & ask questions Problem-Based Learning Small Group Learning 5. Case Discussions 3 discussion cases introduced during Orientation then reviewed during closing in small groups with Program Director Page 9
Module 3 - Mentorship One-on-one Mentoring Ongoing CPD & Consultation 6. Mentorship Trainees each paired with HIVexperienced physician Mentors provide support for 3-6 months Complete a reflection form at the end of 3 months and receive 25 Mainpro-C credits 7. Ongoing CPD Trainees continue to engage with BC-CfE: CME events & conferences, updated guidelines, consultations Page 10
25 Intensive Preceptorship By Health Authority 79 primary care providers (59 Family Physicians, 20 NPs) trained since 2011 20 15 2 6 Fraser Island Health Authorities: VCH, Interior, Island, Fraser 10 18 1 4 9 3 Interior Vancouver Coastal 5 8 8 9 4 0 2011 2012 2013 2014 2015 2016 4 3 Page 11
40.0 Changes in Physician Prescribing Practices & HIV-related Patient Outcomes Median per Physician 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 1 Yr Before Training Average/Yr After Training p-value* # of HIV-positive patients 3.5 5.2 0.032 # of ART Initiation/Change 0.0 0.7 0.073 # of ART Refill (of existing prescription) 8.0 19.9 0.063 # of viral load tests requested (total) # of patients who had viral suppression 8.0 35.2 0.001 1.0 2.7 0.005 Page 12
Post- Clinical Placement Evaluations The clinical rotation met the pre-established learning goals 97 % Overall, I found the Preceptors to be helpful 97% Found the following useful: Online course 97% Lunchtime tutorials 100% Case studies 100% Which aspects of the clinical rotation did you find the most useful or helpful / or less useful / or helpful? Narrative Agree and Strongly Agree Post Mentorship Evaluations (3 months later) How many HIV-positive patients in total do you see in your practice? > 6 patients: 66% Please compare your level of knowledge and skills in the following 5 areas between now and before you started your Intensive Preceptorship. Do you think that you would benefit from an additional prolonged preceptorship (more than one week)? Increased: 100% Yes: 40% Currently, how do you find information about HIV? Please check all that apply. On line resources/cfe guidelines Can you identify any gaps in support and/or resources that, if filled, will allow you to take additional HIV-positive patients? More community support in remote areas Page 13
Academic Achivemetns Medical Teacher 2015 Learner Satisfaction Performance Improvemen t CCME 2016 Performance Improvemen t Patient Outcomes Page 14
Conclusions The BC-CfE developed and evaluated an innovative training program for primary care providers. This HIV training program has demonstrated a positive impact on physicians and their: prescribing practices adherence to guidelines HIV-related patient outcomes This training model could be applied to other chronic diseases or other provinces that deal with a high burden of HIV infection. Page 15
Thank you Page 16