Patient-centered medical home to target poor adherence to antiretroviral therapy and retention in care for patients with HIV
Tuesday, November 5, 2013
: 11:00 a.m. - 11:15 a.m.
Issues: As we prepare for the Accountable Care Act in 2014, we created a staffing plan for a community HIV non-profit agency. High adherence to antiretroviral therapy is the key to maintaining suppressed HIV viral load and better health outcomes. In the Gardner cascade, poor retention in care also leads to low rates of suppressed viral load in populations of patients. We evaluated this cascade for our patients to determine where patients are lost to care and to design a patient-centered medical home. Description: We measured 30 day pharmacy fill rates (number of days supply/number of days between fills) for the primary antiretroviral medication in each patient's regimen with a 95% cut off for inclusion in the intervention. Retention in care was measured using the number of visits with a cut off of two visits per year. Lessons learned: Our analysis demonstrated overall low rates of adherence and retention in care. We designed an integrative, interdisciplinary, co-located, patient-centered medical home offering primary care, behavioral health services, and dental care. The model utilizes patient navigators and psychotherapists to motivate patients with low adherence or poor retention in care using a problem-solving approach to improve outcomes. Based on our current data, the team should include a medical provider, a medical assistant, 2 psychotherapists, and 4 patient navigators. Recommendations: Patients with less than 95% adherence or less than two visits per year should be targeted to participate in an integrative, interdisciplinary, collaborative, co-located primary care/behavioral health patient-centered medical home to improve outcomes.
Clinical medicine applied in public health
Other professions or practice related to public health
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Systems thinking models (conceptual and theoretical models), applications related to public health
Define the key components of a patient-centered medical home for patients with HIV
Discuss a method for using pharmacy fill rates to measure adherence to antiretroviral therapy
Keyword(s): Access to Health Care, Adherence
Presenting author's disclosure statement:
Qualified on the content I am responsible for because: I have been the lead author on multiple peer-reviewed publications focusing on adherence to antiretroviral therapy. I am a family physician with 10 years of clinical experience, and I am the Director of Community Health Services for an agency planning to become a patient-centered medical home.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.