OVERVIEW OF THE TELEHEALTH PROJECT FOR PERSONS WITH HIV
(PWH)
Reetu Grewal, MD
Nipa Shah, MD
DISCLOSURES
This project is funded by the Centers
for Disease Control
PS17-1710
ACKNOWLEDGEMENTS
• Centers for Disease Control
• Health HIV
• Community Advisory Board
• Community Based Organizations
• JASMYN
• NF AIDS Network
• River Region
• Nassau County Health Department
• Beson 4
TELEMEDICINE AT UF JACKSONVILLE
• TM Program started in 2014
• Consent, legal, billing, technical, safety/security, educational aspects
were addressed primarily
• Staff resistance and insurer payments were main barriers.
• Neurology & Family Medicine
• September 2017 awarded CDC funds to tailor existing TM
program to PLWH
TELEMEDICINE PROJECT FOR PWH
• Goals:
• Tailor TM program for PWH, in urban setting, especially minority PWH
• Goal >200 unique PWH via TM
• Medical Care
• Ancillary Services
• Other Outcomes:
• Viral Load
• Patient/Provider attitudes towards TM
• Cost Analysis of TM
TELEMEDICINE TIMELEINE FOR PWHPROJECT
• September 2017-September 2018
• Planning Year
• Implementation Period
• September 2018-September 2020
HIV PANDEMIC IN JACKSONVILLE
Table I. HIV Incidence, Prevalence & Mortality &
Socioeconomic Characteristics for Duval County (Jacksonville
FL) residents
2015
HIV rates per 100,000 (106) population
(2013-2015)
Blacks Whites
HIV Infection rate (incidence) 73.1 13.3
HIV cases (prevalence) 47.4 7.7
HIV/AIDS age-adjusted deaths
(mortality)
15.1 2.8
Socioeconomic status (2015)
Living below poverty level (%) 28.7
±1.2
12.3
±.6
Graduated high School (%) 83.3 ±1.2 90.9
± .5
Household income ($ median) 33,145
±980
54,447
±1078
WHAT’S THE PROBLEM WITH CURRENT CARE?
Stigma being seen at HIV clinic
Access to transport
Wait/Visit Time
Lost Income Missed Work
Daily Caseload
Full Schedule
Limited time for complex
care
Utilization of Emergency
Care
Telemedicine is effective in rural areas where access to HIV
specialists is limited. Can it work in the urban setting too?
HOW TO ACCESS CARE
PROGRAM DEVELOPMENT
Capacity Building/Infrastructure
- SOPs
-Provider/Staff Training
-Organizational Infrastructure
-Equipment & Installation
-Reimbursement
-Tech Support
Promotion and Marketing
- Material review & development
- Beson4
-Dissemination & Knowledge Sharing
Community Engagement
- CAB
- Press Releases
Program Metrics and Evaluation
- Data reporting process
- EPMP
Implementation & Barriers
- UF CARES
- UF CHFM
- CBOs
CAPACITY BUILDING/INFRASTRUCTURE: UF CARES
• Services
– Pediatric care
– Chronic Disease
Treatment: HIV, Hep B/C
– Gynecology
– Social Work/Case Mgmt
– Psychology
– Pharmacy
ELIGIBILITY CRITERIA
• Clinical: Diagnosis of HIV
• MyChart: Patient has an active MyChartaccount
• Established patient:
• UF CHFM: Patient has been seen in the UF Health system within the last year and their HIPAA Acknowledgement and Consent for Treatment forms will be valid (less than one year old) at time of the Virtual Visit.
• UF CARES: Patient has been seen at UF CARES of UF CHFM (for HIV related care) within the last 6 months and their HIPAA Acknowledgement and Consent for Treatment forms will be valid (less than one year old) at time of the Virtual visit.
ELIGIBILITY CRITERIA CONTINUED
• Reimbursement: Insurance covers or grant reimburses
• Tech Capability:
• Patient either has their own, or access to, a Telemedicine capable device (smart phone,
tablet, laptop or computer w/ webcam)
ELIGIBILITY CRITERIA FOR A TM VISIT
• Symptoms that would NOT be appropriate for a Telemedicine Visit:
ANY ACUTE/LIFE-THREATENING ILLNESS
• Medical complications or conditions NOT appropriate for Telemedicine Visit: CD4 count < 200 cells/mm3
Unstable chronic disease Chronic pain – requiring narcotics be prescribed during the
Virtual Visit
EMR UPDATES
Best Practice Alert
PROMOTION & MARKETING
PROMOTION & MARKETING
PROMOTION & MARKETING
PROMOTION & MARKETING
• https://www.youtube.com/watch?v=paoPNecv1b0&feature=you
tu.be
• Patient Education Video
• https://www.youtube.com/watch?v=pVn4a61Ilsg&feature=youtu.
be
https://www.youtube.com/watch?v=paoPNecv1b0&feature=youtu.behttps://www.youtube.com/watch?v=pVn4a61Ilsg&feature=youtu.be
COMMUNITY ENGAGEMENT: CAB
• ~15 members consisting of PLWH patients, community-based organizations (CBOs), academic and medical experts
• Meets Quarterly to review all aspects of project
• Promotion and marketing campaign
• Guidance on program development and implementation
• Focus Group Guidance
PRE-COVID-19 DATA
• As of 8/26/19:
• 71 TM visits conducted
• 58 unique patients
• As of 2/10/20:
• 178 TM visits conducted
• 115 unique patients
• Ancillary Services:
• Psychology (3 visits, 2 unique patients)
• CBO Partners
• Nassau County only
CHANGES POST COVID-19
• UF CARES Clinic is located within/adjacent to UF Health Jacksonville Hospital
• UF Health Jacksonville consolidated entrances for patients and staff
• Eligibility Criteria loosened
• All patients eligible regardless of CD4 count
• All patients are converted to TM visit or rescheduled for later
• New patients can be seen via TM
• Emergency care only in clinic
CHANGES POST COVID-19
• Increase in utilization of TM from community partners
• Most CBOs closed during early pandemic
• PWH used their own technology
• Reimbursement for TM from most insurance plans
• Connection issues mostly resolved with Zoom platform
IMPLEMENTATION UPDATE
• As of 8/10/20:
• TM visits conducted 595
• Unique patients 360
• Ancillary Services:
• Psychology (142 visits, 84 unique patients)
• Pharmacy (28 visits, 18 unique)
• Nutrition (67 visits, 66 unique)
• Case Management (28 visits, 24 unique)
OTHER DATA POINTS
• Focus Group Analysis
• Patients, Providers, Ancillary Staff
• Finalized 2 year data
• Who Utilized TM?
• VL over time
• Stability, Improvements?
• Cost Analysis
• Cost Savings with TM?
THANK YOU!!
mailto:[email protected]:[email protected]