Download First Clinic Visit

First Clinic Visit for Patients
with HIV Infection
HAIVN
Harvard Medical School AIDS
Initiative in Vietnam
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Learning Objectives
By the end of this session, participants
should be able to:
 Explain principles of good chronic
care
 Describe how to conduct a first clinic
meeting with an HIV positive patient
 Explain how to follow up with a
patient after the first clinic visit
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Difficulties Treating Patients with HIV
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HIV is a chronic disease that requires
a lifetime of regular clinical
monitoring
Successful treatment outcomes
require excellent treatment
adherence
HIV treatment is made more difficult
by many social and cultural factors
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Effective Communication Skills
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Effective communication involves:
Actively listening
Attending to a patient
Demonstrating a caring, respectful attitude
Praising, encouraging patient
Speaking clearly and simply at a level the
client can understand
• Encouraging patient to ask questions
• Building rapport
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What is Rapport?
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Rapport is…
• Building a comfortable connection so
that people can share information
• Creating a relationship based on trust
and respect
• Created through both verbal and nonverbal actions
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How to Build Rapport
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Shake hands
Introduce yourself
Use same language as client
Show patience
Do not interrupt
Make eye contact
Do not attend to other clients while
busy with another
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Question:
What are some
principles of good
chronic care?
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Principles of Good Chronic Care (1)
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Develop good treatment partnership
with patients
Listen to patient’s concerns in a nonjudgmental way
Promote patient education and active
participation in care
Encourage involvement of treatment
supporters: family, friends and peer
educators
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Principles of Good Chronic Care (2)
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Link patients to community and
home-based supports
Provide counseling and supports for
better treatment adherence
Work as a clinical team with nurses,
counselors and other health workers
(multidisciplinary team approach)
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The Multidisciplinary Team
Treatment of HIV is best accomplished by a
team, which may include:
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Doctor
 Family members
Nurse
 Case manager
Counselor
 Social worker
Pharmacist
 Peer
educators/PLHIV
Treatment
supporter
 Others (?)
Each team member has specific roles in
the long-term care and treatment process
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Brainstorm:
What are the Elements
of the First Clinic
Visit?
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Elements of the First Clinic Visit (1)
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History of Present Illness
Past Medical History
Medication History
Drug Allergies
Social History
History of tobacco, alcohol and drug
use
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Elements of the First Clinic Visit (2)
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Complete Physical Exam
Assessment of Diagnoses, Current
Problems
Laboratory evaluation
Treatment of OIs, prophylaxis
Counseling
Plan for follow-up
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History of the Present Illness
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Chief complaint
• “Why is the patient in clinic today?”
• Does the patient have any symptoms?
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Ask specifically about symptoms of
tuberculosis
Perform a review of systems
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Past Medical History
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HIV History
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Risk factors for acquisition of HIV
Date of diagnosis
Approximate date of acquisition of HIV
CD4 cell counts (first, lowest, and most recent)
Viral loads (if available)
Opportunistic infections
AIDS-related malignancies
AIDS-related symptoms (e.g. wasting)
Other medical history
• TB
• Hepatitis (HBV, HCV)
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Medications and Drug Allergies:
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Current Medications
• Doctor prescribed
• Self prescribed
• Herbal or traditional medications
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Antiretroviral therapy history
Hepatitis treatment history
Drug addiction treatment (e.g.
methadone)
Drug allergies and adverse reactions
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Social History
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Marital status and children
Family planning
Housing or living situation
Social and financial support from
family, friends, or others
Employment status and occupational
history
Sexual History
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Substance Use
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Current or prior use of:
Intravenous drugs
Tobacco
Alcohol: beer, wine, liquor
Prescription drug abuse
Opium, heroin
Amphetamine-like substances (e.g.
ecstasy, crystal meth)
• Cannabis
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Physical Examination
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A comprehensive physical
examination, including weight and
height, should be performed as part
of the initial evaluation
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Laboratory Evaluation
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HIV antibody for confirmation
Complete blood count (CBC)
CD4 count
ALT
Creatinine
HBsAg
Anti-HCV
Additional testing based on patient’s
symptoms and/or physical examination
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Assessment and Diagnoses
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Determine clinical stage
Diagnose Opportunistic Infections
Assess need for OI prophylaxis
Determine need for ART
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Treatment Plan
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Create a management plan based on
the assessment
Provide counseling and support
Provide appropriate referrals where
indicated
Create plan for follow-up
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Role Play Activity:
Putting These Steps
into Practice
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Key Points
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HIV is a chronic disease that requires
lifetime regular follow-up
From the first visit, it is important to
build a patient-doctor relationship
based on mutual trust and respect
Multidisciplinary team approach is the
best way to care for and treat PLHIV
The first visit is important to evaluate
the patient’s clinical status and make a
treatment plan
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Thank you!
Questions?
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