Belfast Health Advisers SSHA Conference 2008

Anxious Annie and the Heartless Health Advisers

Claire McCluskey & Maeve CrossRoyal, Belfast GUM

Belfast Health Advisers SSHA Conference 2008

Thanks for the Collaboration of:

Suzanne Gray Senior Health Adviser Angela Dorrian Clinical

Psychologist/Supervisor GUM staff Belfast Annie

Belfast Health Advisers SSHA Conference 2008

Introduction: Ideas, Process and Conclusions: Annie’s story Timeline (Assessment/History) What we did What was more/less helpful Interventions: Cards, Leaflet Communication- Collaboration &

Consistency What happens next?

Belfast Health Advisers SSHA Conference 2008

Audit 2007/2008 21 Anxious patients in 1 year 17 Male : 4 Female One third attended three or more times Over half phoned at least twice

Belfast Health Advisers SSHA Conference 2008

Spring '07

Health Advisingteam identified

more timespent with

patients withHIV anxietywho low risk

Devised cardidentification

system forfrequentcallers

Summer '07

Supervision oncoping with

Health Anxiety

Winter '07

Developedleaflet on

anxiety anddiscussed in

team

Spring '08

Feb - April"annie"

presented atclinic

Brought leafletto supervision

Summer '08

Circulatedleaflet to

multidisciplinaryteam

Submit forprinting

Belfast Health Advisers SSHA Conference 2008

Assessment Annie 28, Born N Ireland 10 months ago Annie Kissed a man

whose mum was said to be HIV +ve Total: 5 lifetime partners Married to Phil x 3 years LOSP: 7 years ago Blood transfusion locally, 2 years ago post ectopic HIV risk assessment no other risk

Belfast Health Advisers SSHA Conference 2008

Card

Belfast Health Advisers SSHA Conference 2008

Chapter 1: Claire HIV test only Seen with husband Annie declined antenatal HIV “Reassurance doesn’t last” “what ifs” re negative test

Belfast Health Advisers SSHA Conference 2008

Chapter 1 ? confidence (ectopic) Support? Patient returned in person Urgent test-attended for result-Negative Showed result Began card

Belfast Health Advisers SSHA Conference 2008

Chapter 2. Two Weeks Later: Suzanne Annie phoned Had read on internet about unreliability of

tests Reassured re risks & accuracy of tests Referred again to GP for support Checked out main support Card completed

Belfast Health Advisers SSHA Conference 2008

Chapter 3. Two Weeks Later: Suzanne Annie attended tearful, requesting viral load

test Had been surfing the net! Refused by HA & Dr Reassured re accuracy

Belfast Health Advisers SSHA Conference 2008

Who else knows?

Annie has a psychiatric nurse in the community

GP also aware of testing Husband “frustrated” Family aware Filled card

Belfast Health Advisers SSHA Conference 2008

Chapter 4. The Trouble with Testing: Suzanne HIV result not on computerized lab results Original fax not in notes 2nd test taken Sent urgently Result in person and copy given to patient Incident report Original paper copy from lab put in notes Completed card

Belfast Health Advisers SSHA Conference 2008

Chapter 5. Two Days later: Maeve Annie phoned requesting a viral load Patient has trouble believing her negative

result Referred back to GP for avenues of emotional

support Documented in card

Belfast Health Advisers SSHA Conference 2008

Chapter 6. Three Weeks Later: Claire Patient attended requesting a viral load test Very upset and tearful Discussed support for anxiety Told again re community services and (draft)

anxiety leaflet given HA offered to contact GP to link up support Patient refused Entry in card

Belfast Health Advisers SSHA Conference 2008

Chapter 7. Helpful things Brought case to group supervision

(psychology) Discussed:

Saying “no” Consistency Health Anxiety Model (Slavoski 89) Pulling ideas together more formally in leaflet

(draft to date)

Belfast Health Advisers SSHA Conference 2008

Belfast Health Advisers SSHA Conference 2008

Chapter 8. One Week later: Maeve Conversation overheard by Maeve of medical ward

Dr phoned re extremely anxious woman (Annie) who thought she had HIV-wanted her seen by GUM

Dr discussed with Maeve – awareness raising. Patient seen by consultant in GUM Annie requesting viral load test Dr repeated test on condition he

could contact GP who made contact with Annie.

Belfast Health Advisers SSHA Conference 2008

Chapter 9: A Collaborative Approach

GUM staff involvement (consistent approach) 3 Health Advisers 4 Doctors Clinical psychology (Supervision) Information sharing and updating Confidentiality – Risk & Opportunity in contacting

other support patient has accessed e.g. GP

Belfast Health Advisers SSHA Conference 2008

Lessons Learned: Further Collaboration Opportunity

Husband/Couple work GP Community mental health support CPN Liaison with community groups so we can

refer better Consistency of approach as a

GUM multidisciplinary team

Belfast Health Advisers SSHA Conference 2008

Final Chapter: Positive Outcomes: Lets us work within our competence Give responsibility back Signpost patients to useful support Enhance team communication Feel Okay about saying “no” Cards Supervision Patient leaflet created

Belfast Health Advisers SSHA Conference 2008

Happily Ever After…. ??...