Treatment as prevention levi
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Treatment as Prevention is not a magic bullet on its own. It requires a combination approach that addresses clinical, community, and structural factors. For Treatment as Prevention to work, the "Gardner cascade" needs to change - more testing, linking people to care, keeping them in care, and improving adherence to treatment. Health reform creates opportunities to rethink siloed HIV programs and integrate services through coordinated agencies. This may involve AIDS service organizations transitioning to community health organizations that address social determinants of health with HIV community health workers.
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Laying The Foundation For Health Care Reform: Local Initiatives to Integrate ...
Laying The Foundation For Health Care Reform: Local Initiatives to Integrate ...Philip R. Lee Institute for Health Policy Studies
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This Report describes the factors that affect a local safety net's ability to develop integrated delivery systems and lessons learned from the implementation of 30 safety net integration "best practices".DQ 3-2Integrated health care delivery systems (IDS) was develope.docx
DQ 3-2
Integrated health care delivery systems (IDS) was developed to initiate excellence health care access and quality of care to entire populations and community by collaborating and coordinating diverse healthcare professionals. Main driving force of IDS is patient centered care by using resources such as collaborating care from physicians and allied health care professionals to construct continuum of care, to deliver care in the most cost-effective way, utilize trained and competent providers by utilizing evidenced -based practice and combine innovation such as EHR (Electronic Health Records) system and team work to produce improved healthcare system.
Excellence in care is attainable by incorporating allied healthcare professional, as high quality care is possible when coordination is unified and covers all areas of responsibilities. For an example-combining resources and coordination of care by involving physicians, dietitian, physical therapy or occupational therapy to work with patient diagnosed with obesity by promoting teamwork approach and ultimately delivering endurance in care and utilizing various resources.
Barriers to IDS can be a huge block in delivering quality care. Among many one limitation is physicians not participating in integrated healthcare system, which disconnect physicians from team based approached by deterring continuous quality improvement (essentialhospitals.org, n.d). This is because, system such as EHR or new innovative quality assurance programs are time consuming and overwhelming, thus decline in physicians support in IDS programs. By implementing user friendly system approach, enforcing focused based care and accepting the necessity of evidenced based practice can improve these barriers. Hence, increasing clinical expertise to produce better service and quality of care in integrated delivery system.
Essentialhospitls.org (n.d). Retrieved from: http://essentialhospitals.org/wp-content/uploads/2013/12/Integrated-Health-Care-Literature-Review-Webpost-8-22-13-CB.pdf
Dq 3-1
1.
In the US, there is not one type of health care system but rather a subset of systems, some of them catering to specific populations. These subsystems include managed care, military, and vulnerable populations. Managed care is a health care delivery system that seeks to achieve efficiency by integrating the basic functions of health care delivery, employs mechanisms to control utilization of medical services, and determines the price at which the services are purchased and how much the providers get paid, military health care system is available free of charge to active duty military personnel and covers preventative and treatment services that are provided by salaried health care personnel and this system combines public health with medical services, and vulnerable population subsystem offers comprehensive medical and enabling services targeted to the needs of vulnerable populations and government health insurance programs provide.
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Local Initiatives to Integrate the Health Care Safety Net: Laying the Foundat...
Local Initiatives to Integrate the Health Care Safety Net: Laying the Foundat...Philip R. Lee Institute for Health Policy Studies
A Presentation for The California Program on Access to Care (CPAC) of the UC Berkeley School of Public Health. This presentation is intended to assess where the Safety Net as this state proceeds into full implementation of health care reform.
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Philip R. Lee Institute for Health Policy Studies
University of California, San FranciscoRetention in care projects 052310 nh
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Metrics for Monitoring and Evaluating the Enhanced Comprehensive Prevention Plan
Metrics for Monitoring and Evaluating the Enhanced Comprehensive Prevention Plan
Well Family as a Life Course Focused, Family Fentered System by Go Beyond MCH
Well Family as a Life Course Focused, Family Fentered System by Go Beyond MCH
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Laying The Foundation For Health Care Reform: Local Initiatives to Integrate ...
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DQ 3-2Integrated health care delivery systems (IDS) was develope.docx
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- 1. Treatment as Prevention: Still not the magic bullet Jeffrey Levi, PhD SYNChronicity Conference April 20, 2012 Arlington, VA
- 2. Combination prevention, not magic bullets Clinical (behavioral and biomedical; address syndemics) Community context and mobilization Structural environment (stigma, discrimination, social determinants) US preference for technology rather than addressing context of risk behavior (shared belief among public officials and in affected communities)—yet Tx as Prev. is harm reduction
- 3. For treatment as prevention to work: Change the Gardner cascade Increase testing Missed opportunities in clinical system Get people into care Siloed testing and treatment systems Keep people in care Keep people adherent to treatment
- 4. A new financing environment Our current system is siloed and loses people along the way Health reform changes the context for all programs Medicaid expansion, subsidized coverage New role for CDC and RW programs Rethink the system before rethought for us Start with the individual
- 5. HIV INTEGRATED SERVICES DELIVERY MODEL DEMONSTRATION CDC CMS HRSA/Ryan White State Medicaid CDC surveillance Agency ASO funded by funding with RW/HRSA with enhanced CMS enhanced CMS funding for QA using comm. viral load Coordinating Agency funding for high (could vary by design – Clinical group, ASO, etc.) intensity cases Public Health Dept. Intensive Case Management and Funding according Capitated Medical Care Related Support to insurance status Program Services HIV Testing Services Behavioral Health Services HIV “Prevention for Housing Support Positives” (HUD/HOPWA) Funding SAMHSA Services and Patient Referrals
- 6. Steps along the way… Testing integrated into clinical system Standard of care, reimbursement Mobilization of affected communities Address associated needs Sense of community, social determinants, syndemics, health literacy, adherence ASOs become community health organizations HIV community health workers Financed with RW/CDC funds freed from clinical needs
- 7. A time for hard conversations What is the role of AIDS service organizations in a reforming environment? What does “payer of last resort” mean in a reforming environment? And reform is happening regardless of the outcome of the ACA litigation/election What social/sexual norms do we promote? How do we frame harm reduction?