Bluegrass Care Clinic

1
Bluegrass Care Clinic

• 625 HIV-Positive patients
• 63-county service area in Central and Eastern
  Kentucky
• Ryan White Title II Funding
• Ryan White Title III Funding

2
Bluegrass Care Clinic

• Ryan White Title III
• Direct Services
• Infectious Dis. Specialty
• Primary Care
• Psychiatry
• Mental health Counseling
• Pharm. Counseling
• Medical Case Mgmt.
• Prevention Counseling
• By Referral
• Nutrition counseling
• Specialty care (GI, ENT, etc.)
• Dental and Ophthalmology
• Diagnostic, Radiology, Laboratory Testing
• Family counseling

3
Staff

• Direct Patient Care
• Medical Director
• Patient Services Coordinator
• Infectious Disease MD (5)
• Infectious Disease Fellows (2)
• Primary Care MD (2)
• Clinic Pharmacist
• Mental Health Counselor (LCSW)
• Care Coordinators (6)

4
Services

• Ryan White Title II
• Direct Services
• Infectious Dis. Specialty
• Primary Care
• Psychiatry
• Mental health Counseling
• Pharm. Counseling
• Medical Case Mgmt.
• Prevention Counseling
• By Referral
• Nutrition counseling
• Specialty care (GI, ENT, etc.)
• Dental and Ophthalmology
• Diagnostic, Radiology, Laboratory Testing
• Family counseling

5
Demographics

• Gender ()
• Male 500 (80)
• Female 120 (19)
• Transgender 5 (1)
• Race/Ethnicity ()
• White 478 (76)
• Black 109 (17)
• Hispanic 32 (5)
• Unreported 5 (1)

• Insurance Status ()
• Private 210 (34)
• Medicare 153 (24)
• Medicaid 100 (16)
• No Insurance 156 (25)
• Unreported 6 (1)

6
Demographics

• Age ()
• 2-12 yrs 1 (0)
• 13-24 yrs 16 (3)
• 25-44 yrs 381 (61)
• 45-64 yrs 217 (35)
• gt65 yrs 10 (2)

• Risk Factor ()
• MSM 343 (55)
• Heterosexual 178 (28)
• IDU 33 (5)
• MSM IDU 17 (3)
• Unreported 16 (3)
• Blood Transfusion 15 (2)
• Hemophilia 7 (1)
• Perinatal 2 (0)

7
Options Kick-Off

• Journal Club introduced discussed OPTIONS
  Clinician Initiated HIV Reduction Intervention
  for HIV-Positive Persons
• HIV Monthly Conference focused on OPTIONS with
  Debra Cornman-Teleconference
• Two 1.5 hour trainings session for all clinic
  staff on a Monday/Friday of the same week
• Focused on 2 intense training times
• Didactic, Video with examples and then dedicated
  time for patient role plays
• Lunch was donated by a drug representative
• Enrollment started with myself and Dr. M who had
  been trained in DC

8
Options Intervention Training

• AGENDA Day 1
• Goals of the Options Intervention at the
  Bluegrass Care Clinic Feasibility, Fidelity, and
  Efficacy
• Overview of Motivational Interviewing
• Step-by-Step Review of Options Intervention
  Initial Visit
• RISK MANAGEMENT Discussion of Club Drugs
• Rehearsal of Protocol
• AGENDA - Day 2
• Review of Initial Visit
• Overview of Follow-Up Visits
• Rehearsal of Protocol
• RISK MANAGEMENT Discussion of Sexual Behaviors

9
Total Enrollment

• Dr. T WF, Assoc Prof, ID
• Dr. G WM, Prof, ID
• Dr. M WM, Assist Prof ID
• Dr. NM WF, Clinical IM
• Dr. H WF, Clin Prof ID
• Dr. S Asian F, Fellow
• Dr. B Asian M, Fellow

10
Enrollment UpdateAugust 14, 2006

• 103 Patients Enrollment since March 28, 2006
• 36 Follow Up Surveys completed
• Exit survey is completed at each appointment
• Behavioral Survey is completed every 3 months
• Incentives will be distributed soon

11
Integrated

• Options staff reminded each physician at the
  beginning of clinic to enroll patients
• Options staff and physician identified patients
  for enrollment
• Follow Ups were identified with highlighter on
  daily clinic list
• PRF was easy to find in chart for follow ups

12
Challenges

• One physician was reluctant to be trained
• Tried to get the untrained visiting PA to do the
  work in the clinic
• One physician was agreeable to training but has
  only completed 1 options interview
• Very enthusiastic coordinator left in June

13
Biggest Challenge

• Enrollment of Patients at end of appointment time
• Patients sited the following
• Variety of studies happening at the clinic
  (patients overwhelmed by surveys)
• Patients cant commit to the time for completion
  of surveys
• Work/Personal Obligations
• Long wait to see physician unwilling to wait
  longer

14
Battling Resistance

• Focused on goal of 120 patients
• Weekly Options Enrollment Updates emailed to
  physicians
• Daily reminders at the beginning of each clinic
  to enroll patients
• End Result - One physician not willing to
  Participate

15
Booster SessionJune 23, 2006

• Used to invigorate staff at mid point in study
• Reviewed Progress
• Update from June OPTIONS Meeting
• Reviewed Enrollment Process
• Focused on Follow Up Interviews and Process
• Options Staff Role Play with Physicians

16
Successes

• 43 yo AA Female
• AIDs, previous IDU
• Through interviewing found out she is binge
  drinking
• One goal was to get into mental health care
  first session goal was psychiatrist,
• Second Goal Mental Health Counselor

17
Quotes from Physicians

• Dr. G Success anytime you take time to talk to
  patients about sex in a way that relates
  particularly to them
• Dr. M
• Importance of Impact on Clinic (5)
• Importance of Implementing Techniques Learned (7
  or 8)
• Paperwork interfered in busy clinic