Integrated Practice Unit’s (IPU)
• Organized around the need’s of patient’s
• Provides the full cycle of care for a condit...
Community Health and
Well being
Integrated Practice, Care
For HIV Patients
Veronica Ford
COVENTRY’S INTEGRATED
SERVICE
• An integrated Sexual Health and HIV
service, including Family Planning and
GUM
• Trust cli...
Prevalence of HIV in Coventry
• General population in Coventry of
323,132
• Over 600 HIV patients accessing Integrated
Sex...
Background
• HIV is a complex disease and is considered
to be a treatable Long-Term Condition
• Antiretroviral Therapy has...
IPU - Work to Date
• Development of Screening Tool
• Complies with BHIVA Standards of Care for
People Living with HIV
• Le...
Previous Pathway
HIV
Consultation
Dietician
THT
iAPT
Psychosexual
Counselling
Current progress
HIV
consultation
Lifestyles
service
THT
service
Dietician
iAPT
service
Physiotherapy
Specialist
Psychiatr...
Lifestyle Health Checks
• Individuals aged 18 and above to identify
risks and make healthy lifestyle changes.
• Initial 45...
Lifestyle Health Checks
• Following initial assessment, the client can
attend a structured six week programme to
improve l...
•Delivering parallel healthy lifestyle and
IAPT clinics within the service
• Team encouraging HIV patients to
attend Lifes...
Results so Far
• IAPT has already identified patients who need
help including Cognitive Behavioural Therapy
– Management p...
iAPT
15%
42%
43%
% patients offered IAPT
Service
% patients signposted to
another service
% patients who either did not
ne...
Life Style Support
15%
17%
17%25%
2%
24%
patients to stop smoking
support
patients on counterweight
patients on to IAPT
pa...
Case study 1
• Male, aged 56 years diagnosed positive for 5
years on ART for 4years
• Completed lifestyle health check and...
Case Study 2
• Female, aged 53 years diagnosed 6 years ago
• Supported with behaviour change to ‘sleep well’.
• Her sleep ...
Healthy Lifestyles Sexual Health Feedback Data Analysis
Q6 Do you feel the staff listened to you?
Q7 Is the place where yo...
Healthy Lifestyles Sexual Health Data Analysis
Q2 Q3 Q4 Q5
How would you rate the
appointment times offered to
you?
How wo...
BHIVA STANDARDS
Standard 3
• Provision of outpatients treatment and
care for complex co-morbidity- the IPU
may assist with...
Standard 6
• Psychological care – promotes emotional and
cognitive wellbeing that will impact on the quality
of care and w...
Standard 10
• Participation of people with HIV in their
care – empowering patients to be involved
in the their care pathwa...
• By implementing an IPU we are working to
ensure HIV patients have the best
programme of health care
• Supporting/encoura...
• Reducing admin time to book new appointments
• Reduces DNA rates
• Reducing time and money spend by healthy
lifestyle se...
Future Plans
• Single set of medical records
• Expanding screening tool
• Inclusion of additional services
• Formalising o...
QUESTIONS
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Veronica ford - integrated practice, care for HIV patients

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Better outcomes, better value: integrating physical and mental health into clinical practice and commissioning


Tuesday 24 June 2014: 15 Hatfields, Chadwick Court, London

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Transcript of "Veronica ford - integrated practice, care for HIV patients"

  1. 1. Integrated Practice Unit’s (IPU) • Organized around the need’s of patient’s • Provides the full cycle of care for a condition, including patient education, engagement and follow-up • Involves a dedicated team who devote a significant portion of their time to the medical condition • Providers are part of a common organizational unit • Co-located in dedicated facilities Source: Michael Porter 2010
  2. 2. Community Health and Well being Integrated Practice, Care For HIV Patients Veronica Ford
  3. 3. COVENTRY’S INTEGRATED SERVICE • An integrated Sexual Health and HIV service, including Family Planning and GUM • Trust clinical strategy to develop Integrated Practice Units
  4. 4. Prevalence of HIV in Coventry • General population in Coventry of 323,132 • Over 600 HIV patients accessing Integrated Sexual Health Service • Prevalence of HIV is 3% per 1,000 people aged 15-59
  5. 5. Background • HIV is a complex disease and is considered to be a treatable Long-Term Condition • Antiretroviral Therapy has improved survival dramatically • Co-morbidities including mental heath issues have been identified as important co-morbidities • Management of HIV patients need multidisciplinary team approach • Lifestyle advice and Mental Health Support can improve survival with improved quality of life (BHIVA Guideline)
  6. 6. IPU - Work to Date • Development of Screening Tool • Complies with BHIVA Standards of Care for People Living with HIV • Leading to Single Assessment • Integrated working/joint clinics • Effective use of existing resources • Increased range of services to clients
  7. 7. Previous Pathway HIV Consultation Dietician THT iAPT Psychosexual Counselling
  8. 8. Current progress HIV consultation Lifestyles service THT service Dietician iAPT service Physiotherapy Specialist Psychiatric and Psychological services Alcohol support Smoking support Weight support
  9. 9. Lifestyle Health Checks • Individuals aged 18 and above to identify risks and make healthy lifestyle changes. • Initial 45 minute assessment includes: • BMI measurement • BP, Glucose & Cholesterol testing • Smoking status, diet, physical activity, alcohol consumption • GAD/PHQ for Mood & Anxiety.
  10. 10. Lifestyle Health Checks • Following initial assessment, the client can attend a structured six week programme to improve lifestyle and reduce risk: Eat & Drink Healthy, Be active, Reduce Smoking & Alcohol, Feel good and sleep well Move onto Case Management or Stop Smoking Programme
  11. 11. •Delivering parallel healthy lifestyle and IAPT clinics within the service • Team encouraging HIV patients to attend Lifestyle check •Closer liaison and working between MDT • Onward support offered with a range of external agencies IPU in Practice
  12. 12. Results so Far • IAPT has already identified patients who need help including Cognitive Behavioural Therapy – Management plans agreed with consultant through MDT discussions – Positive feedback from patients and clinicians • IPU assists with the early intervention to reduce the complex co morbidities and also help with the identification of comorbidities such as hyperlipidaemia.
  13. 13. iAPT 15% 42% 43% % patients offered IAPT Service % patients signposted to another service % patients who either did not need or want futher support
  14. 14. Life Style Support 15% 17% 17%25% 2% 24% patients to stop smoking support patients on counterweight patients on to IAPT patients referred to Physiotherapy patients on to Alcohol Support Services patients on to additional case management support
  15. 15. Case study 1 • Male, aged 56 years diagnosed positive for 5 years on ART for 4years • Completed lifestyle health check and was motivated to make lifestyle behaviour changes. • Completed support with ‘Eat Well’ sessions with Lifestyle advisor. • He achieved his goals relating to the frequency of eating, portion size and types of food groups eaten. His starting weight was 103kg and is now 99kg. • Quote – ‘Quite surprising the things you take for granted that are wrong in your life, you think you are doing good but you can do better, fine tuning needs to be done.’
  16. 16. Case Study 2 • Female, aged 53 years diagnosed 6 years ago • Supported with behaviour change to ‘sleep well’. • Her sleep improved and she is also now accessing physiotherapy after being referred following check for her leg problem. • Following the sleep improvement she is now accessing • Counterweight, a weight management programme, with our lifestyle advisor and is following a personal health plan. • She has lost 4.6 kg already and is still on the programme. (Starting weight 75.6kg, now 71kg) • Quote ‘Feel more self-aware and in control of my eating and sleeping; realising that you have habits and somebody is helping you to stop and think. ‘No thank you’ is now my mantra for the week.’
  17. 17. Healthy Lifestyles Sexual Health Feedback Data Analysis Q6 Do you feel the staff listened to you? Q7 Is the place where you go for your appointment convenient for you to get to? Q8 Do you think the support offered by the Health professional has helped you adopt a healthier lifestyle? Q10 What is your overall view of the service? Q11 Focus group NB N/A = Not answered
  18. 18. Healthy Lifestyles Sexual Health Data Analysis Q2 Q3 Q4 Q5 How would you rate the appointment times offered to you? How would you rate the greeting you received from reception staff/Health professional on arrival? How would you rate the approach ability and professionalism of the health professional? How would you rate the explanation of the programme and the information given to you? Q9 What is your overall view of the service? Excellent, 4 Excellent, 7 Excellent, 6 Excellent, 6 Excellent, 5 Good , 7 Good , 4 Good , 5 Good , 5 Good , 5 N/A, 2 0 1 2 3 4 5 6 7 8 Q2 Q3 Q4 Q5 Q9 Excellent Good N/A NB N/A = Not answered
  19. 19. BHIVA STANDARDS Standard 3 • Provision of outpatients treatment and care for complex co-morbidity- the IPU may assist with the early intervention to reduce the complex co morbidities and also help with the identification of comorbidities such as hyperlipidaemia. • Access to emotional support and smoking services •
  20. 20. Standard 6 • Psychological care – promotes emotional and cognitive wellbeing that will impact on the quality of care and wellbeing for people attending the service Standard 9 • Promote self-management – smoking cessation to support wellbeing- encouraging a self- management weight plan
  21. 21. Standard 10 • Participation of people with HIV in their care – empowering patients to be involved in the their care pathways . • The IPU helps patients to participate in identifying need and identify and select other areas of care that may help them to live well.
  22. 22. • By implementing an IPU we are working to ensure HIV patients have the best programme of health care • Supporting/encouraging self management to • Wrapping services around the patients, and ensuring the clients do not need to be referred onto other services • Reduction in client waiting time to access other health services Benefits of IPU
  23. 23. • Reducing admin time to book new appointments • Reduces DNA rates • Reducing time and money spend by healthy lifestyle services promoting services e.g. promotional material • Shared equipment and administration support Benefits of IPU
  24. 24. Future Plans • Single set of medical records • Expanding screening tool • Inclusion of additional services • Formalising outcome framework • Training for Sexual Health Staff to undertake the screening
  25. 25. QUESTIONS
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