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

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Overview of Program’s Approach to ARV Management and Role of Adherence Quality Improvement Projects Issues Related to Sustaining Gains

Treatment Adherence Program approach to ARV Management

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Rationale

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First regimen success is best

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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

Treatment Adherence Program approach to ARV Management

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Description of ACHC TAC Approach

 Clinical input versus recording tool  Initial Referral process  Follow up visits  Annual Screening  Weekly interactive group meetings  DOT

Treatment Adherence Program approach to ARV Management

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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

Quality Improvement Projects

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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)

Quality Improvement Projects

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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)

Quality Improvement Projects

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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)

Quality Improvement Projects

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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

Quality Improvement Projects

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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)

Quality Improvement Projects

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Recommendation

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Establish internal QA/QI committee Assess deficiencies in HIVQUAL and annual patient satisfaction survey

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Address deficiencies

 PDSA project  Strategy – Goal – Action – Timeline 

TAC continuing education

 seminars, self-CME, classes

Issues Related to Sustaining Gains

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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