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AIDS Community Health Center
Treatment Adherence Program
CHC Quality Learning Network
AIDS Institute
April 12, 2007
Roberto Corales, D.O.
Danita Djeloski, MD
AIDS Community Health Center
Presentation Goals
 Overview of Program’s Approach to ARV
Management and Role of Adherence
 Quality Improvement Projects
 Issues Related to Sustaining Gains
Treatment Adherence Program
approach to ARV Management
 Rationale
 First regimen success is best
 Factors of poor adherence
 Psychiatric co-morbidities
 Substance abuse
 Dual roles/psychosocial issues
 Adverse effects
 Poly pharmacy
 Direct Observe Therapy (D.O.T.)
 Patient Education, Empowerment, Responsibility
Treatment Adherence Program
approach to ARV Management
 Description of ACHC TAC Approach
 Clinical input versus recording tool
 Initial Referral process
 Follow up visits
 Annual Screening
 Weekly interactive group meetings
 DOT
Treatment Adherence Program
approach to ARV Management
 Strengths
 Part of multi-disciplinary team approach
 Medication list
 Medical quality assurance (CME, lectures, conferences, self-read)
 3-year increased patient satisfaction in the Treatment adherence
program
 Clinical Studies
 Improvements
 Graduating from the program
 Reducing the no-show rate (currently 10%)
 Secured medication storage for weekly follow ups and D.O.T
Quality Improvement Projects
 Weekly clinical sessions with pharmacist
 Drug-drug interaction
 Pharmacokinetic
 Results:
 Increased understanding of mechanism of drug-drug
interactions and drug contraindications
 Increased knowledge of basic pharmacokinetics of different
HIV medications
 Knowledge gained transfers to patient
 TAC-Patient trust
 Improvement in patient satisfaction (annual survey)
Quality Improvement Projects
 Weekly treatment adherence group meetings
 Educational topics
 Mediator – patient interaction
 Guest lecturers
 Results:
 Patients support group
 Increased knowledge of basic issues with adherence
 Increase % adherence (HIVQUAL indicator)
 Improvement in patient satisfaction (annual survey)
Quality Improvement Projects
 Weekly case management team
 Communication with clinical team members
 Feedback loop mechanism
 Results
 Better understanding of overall patient clinical and
psychosocial issues
 Improve patient satisfaction (annual survey)
 Improve patient % adherence (HIVQUAL indicator)
Quality Improvement Projects
 Prior authorizations
 Role in assisting with acquiring prior authorizations
 Heightened awareness of medical pharmaco-economics
 Increase in knowledge of drugs in specific class
 Results:
 Efficiency in prescription turn around
 Improvement in patient satisfaction (annual survey)
 Improvement in % adherence (HIVQUAL) indicator
Quality Improvement Projects
 Weekly HIV lectures
 Interactive approach with selected topics per semester
with assigned readings
 Increase knowledge
 Core HIV pathophysiology, ARV management,
Adverse events, Adherence
 Results
 Improved TAC knowledge of HIV and ARV management
for better counseling with patients
 Improve patient satisfaction (annual survey)
Quality Improvement Projects
 Recommendation
 Establish internal QA/QI committee
 Assess deficiencies in HIVQUAL and annual patient
satisfaction survey
 Address deficiencies
 PDSA project
 Strategy – Goal – Action – Timeline
 TAC continuing education
 seminars, self-CME, classes
Issues Related to Sustaining Gains
 Organizational Experience
 More clinical approach
 Increased active participants in weekly groups
 Meet and exceed AIDS Institute goals
 Number of actively enrolled patients
 Improved % adherence (HIVQUAL indicator)
 Improvement of overall 3-year patient satisfaction
 Involvement in clinical trials