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Partnership for Health

Experience at AIDS CareRoberto B Corales, DO, AAHIVS

Medical Director & Principal Investigator

September 15, 2011

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Introduction• Partnership for Health is an intervention aimed at every ACHC patient.

It is to promote safer sex practices condom negotiation skills) and to identify referrals for individual with high risk sex practice

• Other DEBI* include: voces/voices, mental health

• Unique DEBI intervention:

• ACHC uses peer educators and outreach workers to engage patients during their clinic visits. They encourage and engage patients to review PfH materials that are available in the waiting rooms and re-inforce the prevention messages.

• ACHC has also re-designed education materials to be more visible and portable (PfH content was NOT changed)

• ACHC has also made available 3 safer sex education kits, which are located in clinic interview rooms, to assist inproviding hands-on learning (male and female condoms)

*DEBI: diffusion of effective behavioral intevention

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Trainings

• First training in 2005

• AETC (AIDS Education Training Center) – Ask Screen Intervene (ASI)

• 4 modules

• I: Risk screening

• II: Universal Prevention

• III: Tailored Behavioral Intervention

• IV: Partner services

• Re-training in October 2008

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7/05: sticker

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2/06: incorporated in our progress note template

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12/07: added in the EMR template (EHS)

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sticker

12/07: added in the EMR template (EHS)

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Annual Reporting to the CDC (7/08-7/09) (excerpt)

Agency name

Intervention/Program

model

Target Population

Recruitment locations

Number of sessions,

waves, cycles,

Activities, Encouters,

etc..

Number of clients

enrolled during the reporting

period

Number of clients

successfully completing

required sessions

Key core activities

Number clients

completing key core activities

ACHC Partnership for Health

HIV/AIDS positive men and women

engaged in high risk

sex practices

and behaviors

ACHC patients

2,125 649 560 Not requested

560

Approximately 10 pages with narrative and graphs.

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DEBI program Models SMART Process Objectives

Agency Name DEBI Program model List your SMART Process Objectives

Discuss progress made toward each

stated process objective for the reporting period

ACHC Partnership for Health 1. By June 30, 2008, 100% of ACHC staff will be retrained in the PfH Interventions

2. By June 30, 2008, 90% of ACHC clinical staff will be actively participating in the Partnership for Health Intervention

3. By June 30, 2008 new patient education materials will be introduced and incorporated into the Partnership for Health intervention

1. Objective met 9/19/08. In order to assure ongoing maintenance of the integrity of program process and maintenance of staff knowledge, a re-training has been scheduled for 10/08

2. Objective previously met, but due to recent clinical turnover, re-training is scheduled

3. Objective met. PfH education materials are widely incorporated in PfH process by clinical staff, displays and brochures throughout the clinic

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DEBI program Models SMART Outcomes Objectives

Agency Name DEBI Program Model List your SMART Outcome Objectives

Discuss progress made toward each stated outcome

objective for the reporting period

ACHC Partnership for Health 1. By June 30, 2008, 55% of HIV-positive patients seen in follow up visits will receive PfH intervention

2. By June 30, 2008, 85% of new HIV-positive patients seen will receive the PfH intervention

3. By June 30, 2008, 20% of HIV-positive patient will receive condom demonstrations

4. By June 30, 2008, 50% of HIV positive ACHC patient seen for follow up visit will report using safer sex practices

1. Objectives exceeded. 86% of positive patients follow up visit received the PfH intervention

2. Objective exceeded. 100% of new positive patients received the PfH intervention

3. Objective exceeded. From the last reporting cycle 181 (an increase of over 300%) of positive patients received condom demonstrations

4. Objective exceeded. >90% of patients seen during follow up visit reported using safer sex practices

If an outcome objective was not met, explain and discuss strategy for improvement

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So, how do these process, outcomes and intervention

change the STD transmission?

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STD cases

Year CT GC Syphilis TOTAL2004 0 9 1 10

2005 0 3 7 10

2006 5 7 7 19

2007 4 3 4 11

2008 6 5 6 17

2009 8 5 0 13

2010 13 3 0 16

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• Need county-wide clinics initiative and buy in

• PfH should be at every clinic

• Patient reporting accuracy (underreporting of % condom use)

• Patient reporting fatigue (“just say yes to all”)

• Providers intervention at every follow up visit (clinical staff buy in)

Thoughts from this experience

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• Re-design templates

• Re-assign questioning role to Medical Assistants

• Need to easily “query” the data

• Bi-annual audits to track and trend

• PDSA

Changes and modifications

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PfH eMDs template (draft)

9/11: added in the new EMR template (eMDs)

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The End