Implementing Enhanced Packages of Care

1. Implementing Enhanced Packages of Care

2. Today�s topic is �Packages of Care� Packages of Care are one dimension - the content components - of our Model of Care We have just heard about overall packages for adults and kids We will go on to hear about country specific unique enhancements

3. To further frame these presentations, I would like to Focus on the other dimension of our Care Model: The mode of delivery of these packages multidisciplinary, continuity, family focused, comprehensive What do these mean? What do we need to do to achieve them? Focus on what we mean when we speak about implementation Look (quickly) at the relationship between implementation and quality assessment/ improvement

4. Mode of Delivery Multidisciplinary Continuity Family Focused Comprehensive

5. In the era of the rollout, teams are the fundamental building block of: Program leadership Site support On-site multidisciplinary care As we move into the continuity care model, there is so much to accomplish at a visit that care must be shared

6. Teams A group of people in a room is not a team

7. What makes a group a team? Shared vision/Common goals Desire to work together Shared disappointments; shared joy at successes Joint accountability Limited hierarchy

8. What makes a team multidisciplinary? Members represent many cadres Each member contributes a range of expertise that overlaps with others but has unique aspects. The combined expertise of all members is greater than the sum of the parts

9. Teams seldom have these attributes naturally Many have too few members to be truly multidisciplinary Many are involuntary, relationships may be strained and tense (cadre, interpersonal), hierarchy may reign, conflict may be difficult to resolve, consensus may be difficult to achieve, motivation and commitment may be low Teams need structure and maintenance Without these, they can degenerate

10. Tasks Team building Cross training if there are few members Team maintenance

11. Mode of Delivery Multidisciplinary Continuity Family focused Comprehensive

12. HIV in the era of ART is a chronic condition Chronic: Persists over a period of time (Dorland�s Medical Dictionary) Patients may remain healthy for years prior to showing evidence of infection Patients can be very sick Once on treatment, patients may enjoy periods of wellness Patients may get sick again

13. How is continuity care different from acute/episodic care? Role and perspectives of the patient Roles and activities of the provider, team, and site

14. Content of Clinical Visit Acute/episodic: The presenting complaint is central. Continuity: Change over time is central. Health maintenance and prevention are integral to good care.

15. Clinically relevant context Acute/episodic: The patient and his/her body is the focus Continuity: The patient is viewed within the context of family and community

16. Provider role Acute/episodic: The provider reacts Continuity: The provider is proactive

17. Counseling Message Acute/episodic: Take your medicine Continuity: How you can stay healthy: medication, self care, and returning for assessment. Return visits are important for early intervention and to maintain health

18. Patient Role Acute/episodic: Patient receives care. The patient comes to care because of illness Continuity: Patient is a giver and receiver of care. Self-management is the backbone of care. Support for self-management is an explicit part of the care package.

19. Team Acute/episodic: No team is necessary Continuity: There are so many aspects of care that a team, which includes the patient, is needed to ensure that care is comprehensive

20. Site (I) Record keeping Acute/episodic: Scanty recordkeeping is sufficient Continuity: Longitudinal charting becomes important to quality of care.

21. Site (II) Site Management/Organization Acute/episodic: New employees may come and go Continuity: Human resource retention and professional development become important

22. Site (III) Site-external relations Acute/episodic: The site may remain self contained Continuity: The site must interact with the community