A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...

A Guide to Primary Care of People with HIV/AIDS
Chapter 16: Clinic Management
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How should consumers be involved in the
provision of HIV clinical care?
Many clinics have created consumer advisory boards
to participate in planning and quality management.
Experiences have varied greatly, with some advisory
board members educating themselves about the issues
and providing expert input to these processes. Other
boards act more as social event or support groups.
Clinics are likely to have to train board members in
technical background regarding HIV and care provision,
and in the role of advisors. Board members must agree
to confidentiality policies, even though information
about individual patients or staff members should
not be discussed. Clinics have to create meaningful
opportunities for advisory board members to provide
input: this may involve discussion of workplans in
writing grant applications, planning outreach activities,
modifying clinics to enhance recruitment and retention
of patients, and participating in quality management
teams. When consumers are living in poverty or
otherwise difficult conditions, obtaining ongoing
participation of volunteers may require providing
transportation to meetings, meals at meetings, and
reimbursement for childcare or similar expenses.
Some clinics find it useful to pay officers of their
advisory boards in order to enable the officers to devote
adequate amounts of time to the project. If this seems
contradictory to the spirit of volunteerism, we should
remember how much continuing education of medical
and nursing professionals relies on enhancements to
recruit participation. Creating effective advisory boards
takes time, but can be a valuable investment. Advisory
board members, while providing an outside view of the
clinic to the clinic management, often provide useful
community outreach and improve public relations.
Less intensive consumer input involves the use of
periodic satisfaction surveys or questionnaires of clinic
patients, confidential or anonymous mechanisms for
eliciting suggestions, and a publicly accessible grievance
procedure. Clinics with advisory boards use these
mechanisms as well.
What resources are required to provide
comprehensive HIV/AIDS care?
Financial: Patient access is maximized in clinics that
can accept Medicare, Medicaid (including Medicaid
managed care), and county insurance programs.
Clinics should have a sliding fee scale. Clinics should
assist appropriate patients to enroll in the AIDS
Drug Assistance Program (ADAP), to access the drug
coverage or other clinical services that vary by State.
Within designated metropolitan areas, RWCA Title I
funding may be available. Clinics planning to serve a
moderate-to-high volume of HIV patients can apply for
a RWCA Title III planning grant. Clinics serving women,
pregnant women, youth, and families are eligible to
apply for Title IV funding. Clinics may collaborate with
other agencies in seeking RWCA funding.
Personnel: A lone provider whose patients are selfsufficient
or can access community-based services
can “provide” comprehensive HIV/AIDS care. For
most patients, care is more effective if multiple team
members are available at the clinical site.
Facilities: In addition to the usual office layout, other
facilities are useful. An examination room suitable
for gynecologic exams is important. An apparatus for
pulse oximetry is very useful in assessing patients
with respiratory symptoms. Easy access to facilities for
collecting venous blood, urine, and stool specimens
should be available. On-site access to rapid tests that
do not require CLIA certification may be useful, such
as urine pregnancy tests, capillary blood glucose, and
perhaps the newly licensed rapid whole blood HIV
antibody screening test. Laboratory certification to
perform urine analysis and microscopic examination
of vaginal fluid specimens is very useful. Refrigeration
to maintain vaccines and material for tuberculin skin
testing is necessary. Refrigeration also enables the clinic
to provide patients with on-site injection of medications
required once a week or less frequently and to instruct
patients in the use of more frequent injections.
Training and technical assistance: Patients look to
nontechnical staff to corroborate information given by
physicians and midlevel providers. Further, patients
expect the same accepting attitude from all staff
members. Thus, all staff need training in both technical
and cultural matters. One important resource is the
local performance site of the AIDS Education and
Training Center (AETC) funded by HRSA to provide
training and technical assistance to clinics. The
local AETC and the National Clinicians’ Consultation
Warmline provide detailed and patient-specific
education to assist clinicians in making treatment
decisions. Written educational materials for staff, such
as national and regional treatment guidelines, are
available free on the web and are frequently updated.
Many regional and national meetings provide training
in both clinical care and prevention. Assistance with
enhancing and implementing systems of care, including
instituting a quality management program, is also
available from the AETCs. Chapter 18 provides other
resources for training and information.
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U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau