An Urban HIV Telemedicine Program for Specialty HIV Services for - - PowerPoint PPT Presentation

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An Urban HIV Telemedicine Program for Specialty HIV Services for - - PowerPoint PPT Presentation

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An Urban HIV Telemedicine Program for Specialty HIV Services for Underserved Populations in San Francisco Bryan Chin; Alissa Porter; Dan Kurywchak & Malcolm John, MD, MPH Bryan Chin Community Health Program Representative May 23 rd , 2012

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Bryan Chin Community Health Program Representative May 23rd, 2012

An Urban HIV Telemedicine Program for Specialty HIV Services for Underserved Populations in San Francisco

Bryan Chin; Alissa Porter; Dan Kurywchak & Malcolm John, MD, MPH

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  • The delivery of healthcare service using telecommunications technology
  • Common use in rural and international settings

At 360-UCSF:

HIV health specialty services (nutrition, pharmacy, etc.) via real-time, secure broadband video connections in urban setting

Launched September 2008, first urban model of its kind

180 patients have participated in both group and individual sessions – most with repeat visits Why Urban Telehealth?

Public transportation limitations

Patient challenges

Resource allocation/sharing

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750 patients served annually

  • 68% Caucasian
  • 18% African American
  • 7% Hispanic, 6% API
  • 75% Identify as MSM
  • 60% private insurance, 40%

Medicare/MediCal Programs

  • Men of Color Program & Black Health

Center of Excellence

▪ Urban HIV Telehealth ▪ Shared Medical Appointments

  • HIV & Aging

Services offered

  • Primary Care
  • Nutrition
  • Pharmacy
  • Psychiatry
  • Case Management / Social Work

/ Peer Advocacy

  • Support Groups / Social

Activities

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Maxine Hall Health Center Haight Ashbury Free Clinic Black Coalition on AIDS South of Market Health Center 360: The Positive Care Center at UCSF San Francisco AIDS Foundation

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35 Physician-referred patient consultations during first year

  • 23 nutrition and 12 pharmacy consults
  • 31 men and 4 women

12 Drop-in Sessions 4 Group Telehealth Education Sessions

  • 8-12 individuals per group
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First-Year Patient Characteristics %

HIV 100% Age (Range 24-59 years) Male 87% Female 13% AIDS 34% Hepatitis B/C 26% Substance Abuse History 43% MediCal/Medicare Insurance 43% Healthy SF (Low Income Insurance) 35% No Health Insurance identified 13% Baseline Labs CD4+ Count <200 9% CD4+ Count >200 91% HIV1 RNA <75 copies/mL 35% HIV 1 RNA >75 copies/mL 65%

Median (Range)

HIV1 log (N=15)

4.40 (1.63-5.70)

CD4+ Count (N=23)

358.5 (59-635)

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74% 24% 2%

Nutrition Pharmacy Other

Type of Telehealth Services Accessed

22% 42% 6% 9% 3% 18% White AA Asian Latino/Hispa nic Other Unknown

Ethnicity of Individual Telehealth Patients

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5 10 15 20 25

Strongly Disagree Disagree Neutral Agree Strongly Agree

  • 79% agreed or strongly agreed that

telehealth answered their health questions adequately, while 17% were not sure and 5% strongly disagreed

2 4 6 8 10 12 14 16 18

Strongly Disagree Disagree Neutral Agree Strongly Agree

  • 59% believed telehealth technology is

confidential; 24% not sure of confidentiality and 17% disagreed that it is confidential

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Telemed 79% Travel to UCSF 9% Both 12%

Which Modality Would You Prefer for Next Visit?

88% felt quality of visual image satisfactory to very satisfactory

98% reported audio quality as satisfactory to very satisfactory

Overall, 90% of patients (30 of the 33 who chose to answer) preferred a telehealth consultation again rather than traveling to UCSF for consultations

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 Patient Characteristics: The first-year preliminary data

indicated 1/3 of total users were uninsured, a population we cannot otherwise see at 360-UCSF.

 Services Utilized: Most patients felt that telehealth

consultations with a pharmacist and nutritionist were helpful.

 Patient Satisfaction: Despite concerns about

confidentiality, patients were overall very satisfied with their telehealth experience, believing that their consultation(s) adequately addressed their health questions, and preferred this modality of service rather than commuting for needed HIV subspecialty services.

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 Lessons learned

  • Coordinators a.k.a. “Champions” needed at all sites
  • Scheduling during site-specific HIV clinics or visits with

primary provider (“One Stop Shopping”)

▪ Data from January 2012 – March 2012:

▪ Maxine Hall Health Center: 8 out of 23 appts actualized ▪ South of Market Health Center: 10 out of 13 appts actualized

  • Anticipating drop-ins
  • Anticipating technical issues
  • Billing/Contract

 Future directions

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UCSF

  • Malcolm John, MD, MPH
  • Melody O’Donnell, RD, CDE
  • Cristina Gruta, PharmD
  • Jeff Jorgenson
  • David Kelegian

South of Market Health Center

  • Arlene Gonzales, RN
  • Cristina Sprague, FNP, WHCNP

Haight Ashbury Free Clinic

Maxine Hall Health Center

  • Catherine James, MD
  • Bruce Occena (SFDPH)
  • Kristalia Williams

San Francisco AIDS Foundation

  • Jeffery Leiphart, PhD
  • Lawrence Lowery
  • Marcos Hardman

Black Coalition on AIDS

  • Perry Lang
  • Adrian Tyler
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 Malcolm John, M.D., MPH: Director

malcolm.john@uscfmedctr.org

 Bryan Chin: Community Health Program Representative

bryan.chin@ucsf.edu (415) 353-2282

 Jeff Jorgenson: Deputy Director, Telehealth at UCSF

JorgensonJ@medsch.ucsf.edu ******