Transcript No Slide Title

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
 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
 Rationale
 First regimen success is best
 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
 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
 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
 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
 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
 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
 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
 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
 Recommendation
 Establish internal QA/QI committee
 Assess deficiencies in HIVQUAL and annual patient
satisfaction survey
 Address deficiencies
 PDSA project
 Strategy – Goal – Action – Timeline
 TAC continuing education
 seminars, self-CME, classes
Issues Related to Sustaining Gains
 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