Strategies for Staying Current in HIV Care: Panel Discussion Steven P. Bromer, MD Clinical Professor University of California San Francisco San Francisco, California FORMATTED: 12/04/15 New Orleans, Louisiana: December 15-17, 2015 Learning Objectives After attending this presentation, participants will be able to:
Identify 1-2 sources for live and archived HIV related CME Describe the role of consultation in maintaining clinical expertise List 1-2 resources offered by the AETC program that can support your clinical role Slide 2 of 49 Panelists
Michael S. Saag, MD David H. Spach, MD Carolyn Chu, MD, MSc Ronald Goldschmidt, MD John Nelson, PhD, CNS, CPNP Slide 3 of 49 Landon, B. E. (2005). Physician Specialization and the Quality of Care for Human Immunodeficiency Virus Infection. Archives of Internal Medicine, 165(10), 1133.
Slide 4 of 49 Landon: Specialization and Quality of Care JAMA 2005 RWHAP- funded care settings Assessed relationship of quality outcomes between generalists, with and without HIV expertise and ID specialists 5000 unique patients, multiple sites Landon, B. E. (2005). Physician Specialization and the Quality of Care for Human Immunodeficiency Virus Infection. Archives of Internal Medicine, 165(10), 1133. Slide 5 of 49
Landon: Specialization and Quality of Care Generalist with HIV-expertise same outcomes as ID specialists Low volume and non-expert providers did not perform as well Expert generalist should be part of the HIV workforce Landon, B. E. (2005). Physician Specialization and the Quality of Care for Human Immunodeficiency Virus Infection. Archives of Internal Medicine, 165(10), 1133. Slide 6 of 49
Professional Organizations Definition of HIV Specialist HIVMA AAHIVM Experience Management of 25 HIV-infected patients in preceding 36 months Training/CME
At least 40 hours of HIV CME in preceding 36 months Expertise Board Certification/5 years of experience if no Board Certification Direct care of at least 20 HIV patients in preceding 24 months
30 hours of HIVrelated CME credits in past 24 months Credentialing Exam (previously every 2 years, now every 3 years) Slide 7 of 49 Recent Research: Volume
ONeill, M., Karelas, G. D., Feller, D. J., Knudsen-Strong, E., Lajeunesse, D., Tsui, D., Agins, B. D. (2015). The HIV Workforce in New York State: Does Patient Volume Correlate with Quality? Clinical Infectious Diseases, 61(12), 18711877. Slide 8 of 49 Recent Research: Volume 33% of NYS HIV ambulatory care providers care for <20 patients Scores on basic HIV performance measures, including viral suppression higher for those providers with > 20
patients (56% vs.77%) ONeill, M., Karelas, G. D., Feller, D. J., Knudsen-Strong, E., Lajeunesse, D., Tsui, D., Agins, B. D. (2015). The HIV Workforce in New York State: Does Patient Volume Correlate with Quality? Clinical Infectious Diseases, 61(12), 18711877. Slide 9 of 49 Essential Components of HIV Care Gallant, J. E., Adimora, A. A, Carmichael, J. K., Horberg, M., Kitahata, M., Quinlivan, E. B., Ryan White Medical Providers Coalition. (2011). Essential components of effective HIV care: a policy paper of the HIV Medicine Association of the Infectious Diseases Society of Slide 10 of 49 America and the Ryan White Medical Providers Coalition. Clinical Infectious Diseases 53(11), 104350.
Challenges to Staying Current High CD4 nadir, 1st or 2nd line ARVs, UD VL Low CD4panel, nadir, multiple Patient co-morbidities,150 history approximately OIs with patients,of FQHC
RWHAP Part C grant Immunocompromised, intermittent or no ARVs, late diagnosis
ARV management/Primary Care Cure Research Poly-pharmacy/Co-morbidities Inflammation Aging and premature aging DDX Social Isolation Opportunistic Infections Complex Mental Health/Social needs Special populations: Women, Co-infection, Adolescent, Illicit Drug Users, Aging
Health Systems Issues: ACA, ADAP, PCMH, Care Teams, MU, Slide 11 of 49 Staying Current Checklist Live CME Self-study/asynchronous resources Community of practice/peer support Consultation/mentorship Supporting colleagues with less experience/teaching Slide 12 of 24 Staying Current: IAS-USA CME and
Educational Activities Michael S. Saag, MD Member, IAS-USA BOD Professor of Medicine Associate Dean for Global Health University of Alabama at Birmingham Birmingham, Alabama FORMATTED: 11/17/2015 New Orleans, Louisiana: December 15-17, 2015 IASUSA Activities
Slide 14 of 58 HIV Activities Targeted to HIV-Experienced Practitioners Live Full-day courses in HIV epicenter cities and archived webcasts Cases on the Web (COWs) Monthly live webinars Topics in Antiviral Medicine Current reviews Resistance Mutations in HIV Guidelines in HIV Copies online or at the registration desk CROI presentations, abstracts, and posters on www.iasusa.org Slide 15 of 58
Guidelines in HIV Slide 16 of 58 Gunthard et al, JAMA, 2014; Marrazzo et al, JAMA, 2014. IASUSA Activities Slide 17 of 58 Visit
www.iasusa.org Slide 18 of 58 Keeping Current with Distance Learning David Spach, MD Principal Investigator, Frontier AETC Professor of Medicine, Division of Infectious Diseases University of Washington School of Medicine HIV Telehealth/ECHO How do you provide updated materials for telehealth?
Updates for Telehealth/ECHO Mini-lectures (15 min) on clinically relevant topics Include cases in same session related to lecture topic Send out real-time relevant updated materials Conference Updates (eg, CROI) AETC National HIV Curriculum How do you create and manage updated curriculum? National HIV Curriculum Dynamic curriculum Content and assessment tools updated
Links to updated guidelines throughout System of flagging updated content Use of Content Management System for ease of updating HIV National Curriculum: Core Competencies Working Group David Spach, MD John Nelson, PhD, NP Sherrillyn Crooks, PA Jeffrey Beal, MD Susa Coffey, MD Fran Cournos, MD John Faragon, Pharm D
Jason Farley, PhD, NP Marshall Glesby, MD, PhD Rebecca Kinney, MD Tonia Poteat, PhD Deborah Storm, PhD, RN Donna Sweet, MD Information Portal Modular Learning
Applied Exercises Challenges & Controversies Question Bank Media Presentations Lesson Topic Review CONTENT National HIV Curriculum: Progress Tracker HIV: Question Bank National
HIV Curriculum: Question Bank Progress Tracker Access as Information Portal Core Concepts Reviews Lectures
National HIV Curriculum: Organized Content Experiences from the National Clinician Consultation Center Carolyn Chu, MD, MSc Associate Clinical Professor Family and Community Medicine University of California San Francisco School of Medicine San Francisco, California Ronald H. Goldschmidt, MD Professor of Clinical Family and Community Medicine, Step 9
Family and Community Medicine University of California San Francisco School of Medicine San Francisco, California FORMATTED: 12/08/15 New Orleans, Louisiana: December 15 to 17 Slide 32 of 49 Patterns by region and caller type 3 3.
Slide 33 of 49 Caller case load - Of HIV Warmline callers who provided information on monthly caseload: - 30.8% provide > 50 services/month 28.9% provide 20-49 svcs/month 18.8% provide 10-19 svcs/month 19.7% provide 1-9 svcs/month 1.7% provide < 1/month
Caller experience/case load 35% 30% 25% 20% 15% 10% 5% 0% Volume + Length of Career Slide 34 of 49
Slide 36 of 49 Distance-based consultation: special features - Decision support allows self-directed learning (options given, multiple care strategies, individualized) - Teachable Moment - Question behind the question - Encourages continuity for time-sensitive,
high-acuity clinical situations (perinatal) - Empowers callers to expand their work - Builds inter-professional teams Slide 37 of 49 The Clinician Consultation Center (CCC) provides clinicians of all experience levels with confidential, timely, cost-free, expert advice HIV/AIDS management (testing, ARVs, co-infection, on: care)
Warmline 800.933.3413 M-F 9 am 8 pm Occupational and non-occupational exposures PEPline 888.448.4911 9 am 2 am
Pre-exposure prophylaxis (PrEP) PrEPline 855.448.7737 M-F 11 am 5 pm Management of HIV in pregnant mothers and infants Perinatal HIV Hotline 888.448.8765 Online Consultation: nccc.ucsf.edu
24/7 www.ncc.ucsf.edu Slide 38 of 49 AETC NCRC John A. Nelson, PhD, CNS, CPNP Program Director FORMATTED: 12/08/15 New Orleans, Louisiana: December 15 to 17
AIDS Education & Training Center Program Regional Centers National Centers Clinician Consultation Center (CCC) National Coordinating Resource Center (NCRC) National Evaluation Center (NEC) http://aidsetc.org/
Slide 40 of 49 Franois-Xavier Bagnoud Center Ways the AETC NCRC Fosters Ongoing Learning Support national communities of practice and other working groups Support technical assistance work for the AETC Program in multiple areas including creating and maintaining mailing groups, social media, a quarterly newsletter, and other mechanisms to facilitate communication, sharing of resources and AETC Program news Serve as the AETC Programs central web-based resource repository of training and capacity development resources by housing all AETC Program
resources on www.aidsetc.org AETC NCRC www.aidsetc.org Slide 42 of 49 Staying Current Checklist Live CME Self-study/asynchronous resources Community of practice/peer support Consultation/mentorship Supporting colleagues with less
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