Saturday, December 16, 2017

OCMA Blog

OC In+Care Newsletter-Issue 5

Newsletter for providers serving people living with HIV/AIDS in Orange County

In the last issue of the In+Care newsletter, we discussed the importance of engaging clients in medical care. In this issue, we will talk about the Continuum of Care, also known as the Treatment Cascade, and how you can help your patients/clients understand the importance of HIV viral load suppression.

The Continuum of Care explains the following stages of HIV care:

  • HIV Infected the total number of people who are estimated to be HIV positive.
  • HIV Diagnosed is the total number of people who have been diagnosed with HIV disease.
  • In HIV Care is the total number of people who see their doctor regularly (at least once every 6 months).
  • Undetectable HIV Viral Load is a HIV viral load count below 200 copies/mL in the blood.stages of HIV care:

According to the Centers for Disease Control and Prevention (CDC), an estimated 14% (or about one in seven) of all people living with HIV disease (PLWHD) in the United States (US) do not know they are positive. Furthermore, about half (52%) of all PLWHD are in HIV care and only 40% of all are virally suppressed in the US.

In Orange County, an estimated 6,698 individuals were living with HIV as of 2014. Of that, 67% (4,492 of 6,698) were linked to a HIV primary care provider and 58% (3,912 of 6,698) had an undetectable HIV viral load. In comparison to national and California data, Orange County fairs better in all stages of the cascade.d count below 200 copies/mL in the blood.stages of HIV care:

Orange County goal for PLWHD by the end of 2015 are:

  • 85% will be in HIV care 
  • 67% with undetectable HIV viral load

Viral load suppression is the key to staying healthy. If your patients/clients have been prescribed antiretroviral therapy, help remind them the importance of taking their HIV medication as prescribed.

According to the CDC, those who are currently on HIV medication will live more than twice as long as individuals who are not on HIV medication.1 Furthermore, suppressed viral load reduces the risk of transmitting the virus to others. A suppressed viral load may also slow the progression towards AIDS.2

In late 2014, Orange County implemented a campaign to remind PLWHD of the importance of seeing their doctor regularly. Due to the implementation of the Affordable Care Act (ACA), nearly 700 PLWHD have transitioned from Ryan White-funded medical care to public and private insurance. This transition has significantly changed how PLWHD access medical care. As a service provider, it is important to support and facilitate continued medical care access and adherence. The following are simple tips to promote medical care adherence:

If you are a medical provider, ask your patients...

  • What Questions do you have about your health?
  • Do you understand your numbers (viral load, CD4, etc.)?

As a provider, you can also...

  • Do reminder calls before visits
  • Follow up on missed visits
  • Coordinate care/adherence with the patient's Ryan White case manager, when appropriate

If you are a support service provider, ask your clients... 

  • When did you last see your HIV doctor?
  • Do you know your numbers (HIV viral load and CD4)?
  • Is your next appointment with your HIV doctor within 6 months?
  • Do you have any questions for your doctor?

The HIV Planning and Coordination website has resources for persons living with HIV. The website can be accessed via the link below:
http://ochealthinfo.com/phs/about/dcepi/hiv/libehiv

1 Centers for Disease Control and Prevention, Vital Signs, November 2014
2 http://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/458/plasma-hiv-1-rna--viral-load--and-cd4-count-monitoring

Our+Care OC is a project of the Orange County HIV Quality Management Committee. The HIV Quality Management Committee works to increase the quality of Ryan White services. For more information about the committee, please call (714) 834-8063. If you have feedback or suggestions for future newsletters, please contact Mindy He at MHe@ochca.com.

Tamarra Jones, DrPH

Program Manager

HIV Planning and Coordination

Orange County Health Care Agency 

 


OC In+Care Newsletter

Beginning in August 2014, the Orange County Health Care Agency (OCHCA) will be taking a closer look at the medical visit frequency of PLWHD in Orange County. OCHCA is interested in increasing the percentage of HIV-positive clients who are maintained in continuous medical care. It is important for patients to stay in continuous care and see their doctor(s) regularly because it may lead to suppressed viral loads and ultimately overall better health outcomes2. In April 2014, the HIV/AIDS Bureau (HAB) published quality management performance measures and recommended that all individuals living with HIV disease should see their medical provider at least once every six months.

Orange County has a goal to increase the percent of PLWHD who are in continuous HIV medical care. Currently 83% of HIV-positive clients in Ryan White–funded medical care are seeing their doctor regularly. Only 60% of all HIV-positive clients in Orange County are maintained in continuous care3. With the implementation of the Affordable Care Act, more clients will access medical care outside the Ryan White system; therefore, the goal is to increase the percentage of HIV-positive clients in continuous medical care for Orange County to 72% by the end of 2015.

The following table provides an overview of the percent in continuous care compared to the 2015 goal.

In Medical Care  Ryan White  All OC 
2010  79%  N/A
2013  83%  60%
2015 (goal)  84%  72%

Orange County-Wide Quality Improvement Goal

Maintenance in medical care is the primary goal of the Ryan White program and all services provided should help ensure HIV medical care adherence. In order to meet the 2015 goal for Orange County, all service providers should ask their clients “When was the last time you saw your doctor?” and “When is your next doctor’s appointment?” Whether you are a mental health provider, or a case manager, food bank provider, or other service provider, you should be asking your clients about their medical care and help them make it to their medical appointments, as appropriate. This quality improvement activity intends to engage patients in HIV medical care from all points of access.

Providers are also encouraged to create their own quality improvement activities to increase retention in care. For example, medical providers can try different reminder alerts to remind clients of their appointment. Case managers may use a strength-based approach to assist clients in attending their next medical appointment.

It is very important to have a good relationship between case managers and doctors. A good relationship allows for better coordination of care between providers. A client’s case manager and medical provider should be communicating about the client’s care on a regular basis.

From PLWHD
Each client is unique and has different needs and different views of what they would like to see from their doctor. See “My Doctor is the Best Because” box for some of the things clients look for in a medical provider.

How to engage PLWHD
  • Ask them if there are any barriers to attending medical appointments. Link them to support services, if applicable.
  • Acknowledge their personal strengths and help them apply it to their treatment plan.
  • Show that you care about their general well-being.
  • Listen to their concerns and respond to their questions.
  • Encourage clients to ask questions.
  • Create a quality improvement activity to retain clients in care.
  • Use posters, brochures, reminder cards to help clients remember to attend their medical appointment.
  • Explain how important it is to attend medical visits even if they are feeling healthy so they can monitor changes in their health, get their medications and review their CD4 and Viral Load.

OC In+Care is a project of the Orange County HIV Quality Management Committee. The HIV Quality Management Committee works to increase the quality of Ryan White services. For more information about the committee, please call (714) 834-8063. If you have feedback or topic suggestions for future newsletters, please contact Mindy He at Mhe@ochca.com.


Orange County Public Healthcare Update: OC In+Care

OC In+Care: Newsletter for providers serving people living with HIV/AIDS in Orange County


Orange County In+Care Goals:

  • Increase the proportion of newly diagnosed individuals linked to clinical care within three months of diagnosis.
  • Increase the proportion of PLWH who are in continuous care.
  • Increase the proportion of PLWH with suppressed viral loads (less than 200 copies per mL).


Barriers to Treatment Adherence

 

Although a patient's ability to commit to a treatment plan should be assessed prior to initiating treatment, unexpected changes in the patient's life can disrupt treatment adherence. There may be many barriers that prevent a patient from adhering to their treatment regimen. Some barriers that may arise are:
 
* Active substance abuse (drugs and/or alcohol)
* Patient feels healthy
* Food requirement
* Forgot or busy
* Away from home
* Traveling
* Change in daily routine
* Side effects
* Depression or illness
* Lack of interest
* Desire to have a drug "holiday"
* Treatment fatigue 


Strategies to Treatment Adherence

 

It is important for the medical provider to understand and be aware of the patient's overall situation. During the appointment, ask the patient if there are any changes in their lifestyle or daily routine that may affect their medication intake. Education should include potential consequences of not adhering strictly to the treatment plan. Let them know that changes in lifestyle may disrupt their treatment plan and remind them of their treatment regimen. Emphasize the importance of committing to the plan even with these changes.
 
A common reason for why many patients discontinue their treatment regimen is because they do not feel sick. Encourage patients to continue their medication even when they are physically feeling well.
 
Communication between the doctor, case manager, and pharmacist (with appropriate release of information) is key to helping them continue to commit to their treatment plan.
 
Some patients may find using a diary or medication log useful in remembering what medications to take and when to take them.
 

The patient can include individuals to support them in their treatment plan. This can be a family member, peer, or friend whom they feel comfortable with and have disclosed their HIV/AIDS status.


The Pharmacist's Role
 
The pharmacist's role in HIV care is essential. A patient may see multiple providers with prescribing privileges, but typically goes to one pharmacy. Because of this, their pharmacy becomes the "hub" for the patient's care. As noted before, it is important for doctors, pharmacists, and case managers (if applicable) to have a good relationship. Doctors should contact the pharmacy to follow up on a patient's treatment plan and more importantly, learn of any other drugs the patient is taking that may lead to drug-drug interactions.
 
Pharmacists should contact the doctor if a patient's treatment plan may lead to adverse effects. Contacting the doctor or case manager may also be necessary if patients are not picking up their medications (non-adherence). 


Orange County Resources
 
Check out HIV THRIVE (hivthrive.com), for information on living with HIV/AIDS and improving overall wellness.
 
Peer Support Services (PSS) offers support to individuals who are living with HIV/AIDS. For more information on PSS, contact Bobby Avalos at (714) 868-1829 or e-mail bobbyonstage@hotmail.com 

Click here to the view the full OC In+Care newsletter.

OC In+Care is a project of the Orange County HIV Quality Management Committee. The HIV Quality Management Committee works to increase the quality of Ryan White services. For more information about the committee, please call (714) 834-8711.
 
Click here to subscribe to the OC In+Care newsletter.
 
If you have feedback or topic suggestions for future newsletters, please contact Melissa Corral at MCorral@ochca.com.

 


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