HIV/AIDS: A 30-Year History of Care Delivery


Patricia L Philbin, RN; Karen Lewis Smith, MHA; Susan McDonald, RN, MSN;
Kathy Brown MD, FACP, AAHIVS; Dan Kent, PharmD

Abstracts from the Kaiser Permanente 2019 National Quality Conference

From Washington

Background: The ability to manage a chronic disease is critical to the Triple Aim. HIV is a chronic disease and with successful management of the disease we can offer the individual the ability to live longer and have a higher quality of life. We can also improve both health outcomes and cost. When we successfully reduce the transmission of HIV to others, we improve our community.
Methods: The HIV program at Kaiser Permanente Washington is based in primary care. The program provides consultative services to the primary care practitioners/champions as well an annual HIV training and monthly updates. In addition, the HIV program works closely with the Special Medication Pharmacy to follow adherence to treatment regimens. The HIV program has taken the key elements of its success and has added a Pre-Exposure Prophylaxis (PrEP) program in the last 3 years. These programs continue to demonstrate a high-quality, cost-effective care model.
Results: Since its inception in 1988, the HIV program has been managed in primary care with an HIV chief expert. The program has evolved from an Excel (Microsoft, Redmond, WA) spreadsheet with a few practitioners to a program with an extensive Epic (Epic Systems Corp, Verona, WI) registry and primary care champions in all our primary care clinics. The program has had many iterations but critical components of the program include establishing a close partnership with our HIV clinical pharmacist, our Special Medication Pharmacy, our Epic partners as well as the HIV community at large. We work diligently with our state, county, and city to assure safety nets for our HIV population. We have used the knowledge we have gained from our HIV model to develop a successful PrEP program.
Discussion: One of the most important take-home messages is the role primary care can and does play in managing HIV as a chronic condition. It does work. One of the limits and learnings of the program is the ability to assure new practitioners are always aware of the resources the program offers. This is particularly true for patients who enter the system with stable HIV disease and have not chosen an HIV champion. Another challenge, as funding sources change, is to continue to be vigilant about community resources that have provided safety nets. Finally, we hope to replicate this model as we further develop our care for the transgender population.

Abstracts from the Kaiser Permanente 2019 National Quality Conference


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