integrating hiv patient navigation services -...
TRANSCRIPT
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Integrating HIV Patient Navigation Services: Lessons Learned from a Leading CBO
March 3, 2015
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Mute your line
Type questions on the chat pod
Chat hosts privately for any virtual difficulties
Participate and stay until the end of the session
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Capacity Building
Assistance for
Community Based
Organizations
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Our Guest Speakers
Arman Lorz CBA@JSI Specialist JSI Research & Training
Institute, Inc. Denver, CO
Caitlin Canfield, MPH Evaluation Coordinator
Louisiana Public Health Institute
New Orleans, LA
Joey Olsen, MPH C.T.R. Manager
NO/AIDS Task Force -
CrescentCare
New Orleans, LA
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By the end of the presentation, attendees will be able to:
Describe five different components of patient navigation (PN) models
List five key tasks performed by patient navigators Identify three elements of a PN program that can be
incorporated into their existing services
Identify how to obtain formal training and receive
technical assistance to integrate a PN services
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What is a Patient Navigator?
Assists clients through the process of accessing medical care and other support
services
Also assist medical providers by preparing clients for their appointments to ensure client engagement
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TELL US
What is your familiarity with patient navigation models?
Do you have a Patient Navigation program or position at your agency?
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National HIV/AIDS Strategy Goals
Primary goals:
1. Reduction of new HIV infections
2. Increased access to care and improvement of health outcomes for people living with HIV
3. Reduction of HIV-related health disparities
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National Patient Navigation Goals
To increase the proportion of: newly diagnosed patients linked to clinical care within three months of their HIV diagnosis
(from 65% to 85%) clients who are in continuous care (from 73% to 80%) HIV diagnosed gay and bisexual men, blacks, and Latinos with undetectable viral load by 20%.
Action steps Establish a seamless system to immediately link people to continuous and coordinated quality
care when they learn they are infected with HIV increase the number and diversity of available providers of clinical care and related services
for people living with HIV Increase the coordination of HIV programs across the Federal government and between
Federal agencies and state, territorial, tribal, and local governments Develop improved mechanisms to monitor and report on progress toward achieving national
goals
from Patient Navigation Programs: What are the Standards? delivered by the CDC Capacity Building Branch on February 20, 2014 9
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Patient Navigation
Patient Navigation is a process which uses inter-related activities to guide a patient through barriers with linkage, retention and re-engagement for life long viral suppression.
from Patient Navigation Programs: What are the Standards? delivered by the CDC Capacity Building Branch on February 20, 2014 10
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Patient Navigation A Model for Success
NO/AIDS Task Force/CrescentCare New Orleans, LA
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HIV and AIDS in Louisiana
HIV: Louisiana ranks 4th in the nation for estimated HIV
case rates when comparing all 50 states New Orleans ranks 5th in HIV infection case rates
among major metropolitan areas in the United States
AIDS: Louisiana ranks 3rd in the nation for AIDS case rates
when comparing all 50 states New Orleans ranks 4th for AIDS case rates among
major metropolitan areas in the United States
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NO/AIDS Task Force (NATF) Background
We have roughly 1,400 HIV positive clients enrolled in our Primary Medical Care s ervices
2013/2014: NATF conducted 3366 rapid HIV tests - 87 were positive - for an overall positivity rate of 2.6%
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NO/AIDS Task Force Comprehensive and Integrated Services
NO/AIDS
Prevention
Medical Care
Medication Assistance
Food Pantry
Peer Support
Behavioral Health
Substance Abuse
Housing
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NATF Linkage Data
88% 92%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
100%
Percent of Newly Diagnosed Positive Clients Linked to Care Within 90 Days - LOPH
77% Patient Navigator Hired
53%
53%
90%
Early July Jan July Jan July Jan NATF Dec June Dec June Dec June Years 2011 2012 2012 2013 2013 2014
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NATF Linkage of All Newly Diagnosed Positives within 90 days
90% 82%
91% 94%
83% 89%
94%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Oct-Dec '12 Jan-Mar '13 Apr-June'13 Jul-Sept '13 Oct-Dec'13 Jan-Mar '14 Apr-Jun '14
Overall Linkage to Care = 90% 16
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Day 1
Client receives positive result with 20 minute oral antibody test
Clients counselor conducts rapid blood test, delivers result in 1 minute
Clients counselor provides additional counseling as needed and calls the Patient Navigator to set up a follow-up appointment
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Day 2
Patient Navigator receives client paperwork
Patient Navigator creates client file, enters client info in to our database, and turns in original paperwork to the Louisiana Office of Public Health
Patient Navigator meets with client, enrolls them in case management and schedules first medical appointment
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LINKED TO CARE!
Linkage to care is achieved when a client attends
nursing appointment where blood is drawn for CD4 and
viral load numbers.
(PN Tracks: attended initial lab/nursing intake and attended first doctors appointment)
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NATF Linkage To Care Key Components for Success
Hybrid Employee
Devoted Funding
Data & EMR
Flexibility &
Personality
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Patient Navigator: A Hybrid Employee
Prevention
Follow up and Linkage
Maintain database & submit reports to Office of Public
Health
Coordinate with local Disease Intervention
Specialist (DIS)
Attend all Counseling & Testing and Linkage trainings
Primary Care
Transportation assistance
Health education
Attend department meetings
Translation as needed
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Patient Navigator: Challenges & Benefits of being a Hybrid Employee
On-call Meet clients same-day Maintain working
relationships with all departments
Challenges
Intimate knowledge of all departments = better experience for client Expedited linkage for
clients that are very sick
Benefits
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Database and Electronic Medical Records (EMR)
Contact information Demographics & Exposure Category New Positive? CTR Data DIS Referral and First Contact Appointment Data Access to EMR
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The Importance of Data Maintenance and Tracking
94% 90% 89% 86%
81% 89%
100%100% 89% 92% 92%
85% 85%
100%
83%
67%
83%
67%
83% 89%
80%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Oct-Dec '12 Jan-Mar '13 Apr-June'13 Jul-Sept '13 Oct-Dec'13 Jan-Mar '14 Apr-Jun '14
Hun
dred
s
Total MSM MSM (excl-YBMSM) YBMSM
Overall Linkage to Care = 90%
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Internal vs. External Records
100%
90%
80%
70%
60%
50% Percent of Newly 40%
30%
20%
10%
0%
Patient 83%
90% Navigator Hired 90% 71%
73% 64%
Diagnosed Positive Clients Linked to Care Within 90 Days - LOPH
Internal Data
Early July - Oct - Jan - Apr - July - Total Jan -NATF Sept Dec March June Sept 2012 Aug Years 2011 2011 2012 2012 2012 2013
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Flexibility and Personality
Flex Time Meet clients in non-
traditional settings Meet new clients same-day High-stress situations
Flexibility
Adept at working with diverse populations, including providers Good at networking Empathize while maintaining
professional relationship
Personality
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SHARE YOUR EXPERIENCE
What challenges have you encountered with linkages to care?
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Challenges with Linkage to Care
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Challenges & Action Steps
Client is in an unstable living
situation
Transportation assistance, case management
Medical and non-medical case management,
Nutritionist, Childcare during appointments
Referral to Behavioral Health,
Peer Support
Client lacks regular access to phone and
email
Healthcare can be a low priority if other needs are
present
Denial, shock, anger, stress
PN cell phone & in community regularly
Work with DIS
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Challenges & Action Steps: YBMSM
Client is in an unstable living
situation
Transportation assistance, case management
Medical and non medical case management,
Nutritionist, Childcare during appointments
Referral to Behavioral Health,
Peer Support
Client lacks regular access to phone and
email
PN cell phone & in community regularly
Work with DIS
Healthcare can be a low priority if
other needs are present
Denial, shock, anger, stress
ACT Program
Code Switch, Flexibility
Pediatric CM, BH, Medical Services
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In Summary
Patient Navigator personality & flexibility
Network with other agencies and providers
Coordinate with your State Office of Public Health/Disease Intervention Specialists
Data consistency and comparability
Data & rates for sub-populations
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In Summary(continued)
Any agency can increase their linkage to care rate. even with limited time and without fancy software.
Develop a Navigation flow that works for your organization.
Constant and clear communication between Navigation Staff
Keep Patient Navigation flow simple
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Contact Info
Joey Olsen, MPH Counseling,Testing, and Referrals Manager NO/AIDS Task Force New Orleans, LA [email protected]
Caitlin Canfield, MPH Evaluation Coordinator Louisiana Public Health Institute New Orleans, LA [email protected]
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What questions do you have?
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High-risk HIV negatives (HRN)
CBA is available to support you in meeting program requirements, such as:
HIP for HRNs, which include: Navigation and prevention essential support services Follow-up support to remove barriers in accessing HIP strategies
and interventions
Outcome: A minimum of 90% of HRNs must be referred to or provided
required and recommended prevention and essential support services through trained navigators
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Navigation For HRN
1. Assessment of risk and need for other services to reduce risk upon presentation for HIV testing services using standard, brief assessment, and conversational procedures.
2. Referral, follow up, and confirmation of linkages.
Common Examples: MSM referrals to couples testing, evidence-based behavioral risk reduction, and biological interventions like PrEP and NPeP.
from Patient Navigation Programs: What are the Standards? delivered by the CDC Capacity Building Branch on February 20, 2014 36
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CBA@JSI Resources
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cba.jsi.com
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http:cba.jsi.com
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Questions?
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Thank you! Do you need additional help?
Find us at cba.jsi.com Submit a request for technical assistance
through CRIS or your health department if not directly-funded by CDC
Please complete the evaluation.
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http:cba.jsi.com
Integrating HIV Patient Navigation Services:Lessons Learned from a Leading CBOSlide Number 2Slide Number 3Our Guest SpeakersBy the end of the presentation, attendees will be able to:What is a Patient Navigator? TELL USNational HIV/AIDS Strategy GoalsNational Patient Navigation GoalsPatient NavigationPatient NavigationA Model for SuccessHIV and AIDS in LouisianaNO/AIDS Task Force (NATF) BackgroundNO/AIDS Task ForceComprehensive and Integrated Services NATF Linkage DataNATF Linkage of All Newly Diagnosed Positives within 90 daysDay 1 Day 2LINKED TO CARE! NATF Linkage To Care Key Components for SuccessPatient Navigator:A Hybrid EmployeePatient Navigator:Challenges & Benefits of being a Hybrid EmployeeDatabase and Electronic Medical Records (EMR)The Importance of Data Maintenance and TrackingInternal vs. External RecordsFlexibility and PersonalitySHARE YOUR EXPERIENCEChallenges with Linkage to Care Challenges & Action Steps Challenges & Action Steps: YBMSMIn SummaryIn Summary(continued)Contact InfoSlide Number 34High-risk HIV negatives (HRN)Navigation For HRNCBA@JSI Resources cba.jsi.comSlide Number 39Thank you!