Adherence Strategies

ASO's collaborate with medical providers

Services help patients improve adherence

With HIV/AIDS medical providers and AIDS service organizations (ASOs) all making do with less federal money these days, there is a new model for how the two groups can help more HIV patients with medical treatment adherence through collaboration.

"We understand the relationship between programs with different expertise and similar consumers, and we want to ensure a full access to our range of services," says Sharen Duke, MPH, chief executive officer of AIDS Service Center New York City (ASC) in New York, NY.

"So ASC has numerous partners with medical providers, homeless shelters, drug treatment programs, parent-teacher associations (PTAs), and other community organizations," Duke says. (See brief story about collaboration with homeless shelters.)

ASC's collaborations with medical providers enables health care organizations to preserve their resources and expand access to services for their HIV/AIDS patients, Duke explains.

Some of these collaborations already help patients with medication and treatment adherence, although that soon will become a bigger priority, Duke notes.

"Medication adherence is the next level for us to incorporate into these collaborative models," Duke says. "Right now we're focused on case management."

For example, ASC works with New York Presbyterian Hospital in a way that includes having ASC's case managers involved with the hospital's discharge planning process, Duke says.

"This is unprecedented for an outside entity to be part of the inpatient discharge planning process," she adds.

"When patients are admitted as inpatients from the emergency room, and when they're identified as not connected to outside medical programs, ASC is called in," Duke explains. "We go into the hospital and, with the client's permission, we conduct an intake at the bedside."

On the day of discharge, an ASC professional will be present to escort the client home.

"Then we will pick the client up from his home and bring him to his first outpatient medical appointment post-discharge," Duke says.

"It's a phenomenal service for medical providers," she says. "And for people who are at risk of falling out of care, it's the additional support and social connection that is the difference between getting the continued medical care and falling out of medical care."

While the collaboration with New York Presbyterian Hospital works very well for ASC, patients, and the hospital, it's not a one-size-fits-all type of model, Duke notes.

ASC works with eight or nine hospitals and health centers, and each collaboration is adapted to fit well for that particular medical provider.

"The collaborations are the results of several months of meetings, identifying mutual benefits, designing service models tailored to each site's specific patient needs and administrative needs," Duke says. "Each hospital and health center is different, so the way we work with each of them has to be tailored to fit their culture, structure, and patients."

For example, on Manhattan's Lower East Side, there is a primarily Hispanic population. So ASC provides bilingual staff to support the medical providers there, she says.

In another unique model, ASC works with Harlem East Life Plan (HELP) in East Harlem at HELP's methadone maintenance clinic, Duke says.

ASC has a case management team who works at the site from 7 a.m. to 3 p.m., which are the hours that work best for HELP, she notes.

"We catch folks who are coming in for their methadone appointments, and if someone misses a methadone appointment, we are notified and will go out and find them and bring them in," Duke says. "At HELP, our case managers have expertise in addiction issues because the work there is centered around the methadone clinic."

Another model is one employed in the collaboration with Beth Israel Medical Center.

ASC pays rent to locate case managers in the Beth Israel AIDS clinic, where they work with HIV clients when the clinic's HIV services identify people who would benefit from additional support, Duke says.

Also, the case managers are part of the hospital's social work team.

"While patients are at the AIDS clinic for medical visits, they meet with ASC case managers, who help them identify their needs related to taking their medication," Duke explains. "We do case conferencing and function as a part of the social work team within the medical clinic, and we can provide wrap-around support at our agency."

In yet another example of the collaborations, ASC has a partnership with St. Vincent's Hospital in which the hospital initially had posted an HIV counselor to ASC for the purpose of conducting HIV testing, Duke says.

"When we identify someone as HIV positive, we bring the person back to St. Vincent's Hospital for medical care," Duke says. "This partnership has increased ASC's capacity and taught us how to do HIV testing, so we now have our own HIV testing program."

St. Vincent's still does the confirmatory testing for clients who are identified as HIV positive through ASC's program, she adds.

From the medical providers' perspective, these collaborations enable them to extend their social work departments through ASC's outpatient staff, saving providers hundreds of thousands of dollars in staff time, Duke says.

"We provide home-based services and escort patients to entitlements advocacy and housing assistance," she explains. "The health systems' staff cannot meet the full demand [on their own] because of their limited resources."

"Health systems can't do everything on their own," Duke notes. "The collaboration with a community-based agency that has expertise in providing services within the community and within patients' homes adds value and consistency to sustaining patients in their care."