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Roberto Corales, D.O. Danita Djeloski, MD AIDS Community Health Center

AIDS Community Health Center Treatment Adherence Program CHC Quality Learning Network AIDS Institute April 12, 2007. Roberto Corales, D.O. Danita Djeloski, MD AIDS Community Health Center. Presentation Goals. Overview of Program’s Approach to ARV Management and Role of Adherence

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Roberto Corales, D.O. Danita Djeloski, MD AIDS Community Health Center

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  1. AIDS Community Health Center Treatment Adherence ProgramCHC Quality Learning Network AIDS InstituteApril 12, 2007 Roberto Corales, D.O. Danita Djeloski, MD AIDS Community Health Center

  2. Presentation Goals • Overview of Program’s Approach to ARV Management and Role of Adherence • Quality Improvement Projects • Issues Related to Sustaining Gains

  3. Treatment Adherence Program approach to ARV Management • Rationale • First regimen success is best • Factors of poor adherence • Psychiatric co-morbidities • Substance abuse • Dual roles/psychosocial issues • Adverse effects • Poly pharmacy • Direct Observe Therapy (D.O.T.) • Patient Education, Empowerment, Responsibility

  4. Treatment Adherence Program approach to ARV Management • Description of ACHC TAC Approach • Clinical input versus recording tool • Initial Referral process • Follow up visits • Annual Screening • Weekly interactive group meetings • DOT

  5. Treatment Adherence Program approach to ARV Management • Strengths • Part of multi-disciplinary team approach • Medication list • Medical quality assurance (CME, lectures, conferences, self-read) • 3-year increased patient satisfaction in the Treatment adherence program • Clinical Studies • Improvements • Graduating from the program • Reducing the no-show rate (currently 10%) • Secured medication storage for weekly follow ups and D.O.T

  6. Quality Improvement Projects • Weekly clinical sessions with pharmacist • Drug-drug interaction • Pharmacokinetic • Results: • Increased understanding of mechanism of drug-drug interactions and drug contraindications • Increased knowledge of basic pharmacokinetics of different HIV medications • Knowledge gained transfers to patient • TAC-Patient trust • Improvement in patient satisfaction (annual survey)

  7. Quality Improvement Projects • Weekly treatment adherence group meetings • Educational topics • Mediator – patient interaction • Guest lecturers • Results: • Patients support group • Increased knowledge of basic issues with adherence • Increase % adherence (HIVQUAL indicator) • Improvement in patient satisfaction (annual survey)

  8. Quality Improvement Projects • Weekly case management team • Communication with clinical team members • Feedback loop mechanism • Results • Better understanding of overall patient clinical and psychosocial issues • Improve patient satisfaction (annual survey) • Improve patient % adherence (HIVQUAL indicator)

  9. Quality Improvement Projects • Prior authorizations • Role in assisting with acquiring prior authorizations • Heightened awareness of medical pharmaco-economics • Increase in knowledge of drugs in specific class • Results: • Efficiency in prescription turn around • Improvement in patient satisfaction (annual survey) • Improvement in % adherence (HIVQUAL) indicator

  10. Quality Improvement Projects • Weekly HIV lectures • Interactive approach with selected topics per semester with assigned readings • Increase knowledge • Core HIV pathophysiology, ARV management, Adverse events, Adherence • Results • Improved TAC knowledge of HIV and ARV management for better counseling with patients • Improve patient satisfaction (annual survey)

  11. Quality Improvement Projects • Recommendation • Establish internal QA/QI committee • Assess deficiencies in HIVQUAL and annual patient satisfaction survey • Address deficiencies • PDSA project • Strategy – Goal – Action – Timeline • TAC continuing education • seminars, self-CME, classes

  12. Issues Related to Sustaining Gains • Organizational Experience • More clinical approach • Increased active participants in weekly groups • Meet and exceed AIDS Institute goals • Number of actively enrolled patients • Improved % adherence (HIVQUAL indicator) • Improvement of overall 3-year patient satisfaction • Involvement in clinical trials

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