CMs help HIV patients get care, other support
CMs help HIV patients get care, other support
Holistic approach improves outcomes
At the Open Door Medical Center, a community health center in Ossining, NY, embedded case managers work with patients infected with HIV, helping them navigate the healthcare system and get the medical care and other assistance they need to keep their condition under control.
"The case management program provides all the support these patients need in dealing with their diagnosis. They look at the patients 'holistically' and help them with all of their needs, whether it's family issues, mental health assistance, or help with issues such as housing and meals," says Andrea Beltran Ruggiero, HIV director. The case management program is funded by the Ryan White HIV/AIDS program.
The health center is staffed by three HIV specialists, in addition to family practitioners and other practitioners who can provide much of the care patients need in one setting; including optometry, nutrition, and mental health services. Since the center provides care for patients with a variety of ailments, HIV patients feel their confidentiality is protected when they see their practitioner.
The biggest barrier that case managers face in ensuring that patients with HIV get the care they need is overcoming the stigma associated with the condition, Ruggiero says. "This is a small, tight-knit community, and being infected with HIV can affect patients' relationships with their families and friends and they fear having people know about their condition," she says.
The HIV case managers are trained as test counselors and see all patients at high risk for HIV. If a provider suspects domestic abuse, or substance abuse, a sexually transmitted disease, or other red flags, they refer the patient to the HIV test counselor. New York state law recommends HIV testing to anyone over the age of 13, which helps eliminate the stigma barrier to being tested, Ruggiero says.
If the results are positive, the case managers meet the patients when they come back to the clinic for post-test counseling with a provider. They talk to them about enrolling in case management and other programs at the clinic.
The case managers help patients enroll in assistance programs such as the AIDS Drug Assistance Program (ADAP), administered through the New York State Department of Public Health. "Most patients are eligible for some kind of assistance," Ruggiero says.
The case managers are trained to talk about treatment options, making sure the patients understand the process and the importance of getting proper medical care. "We have an intricate and very crucial process in place to help these patients come to terms with a very difficult diagnosis," she says. The case managers educate the patients about HIV and assure them that it's a chronic disease and that they aren't likely to die in a few months as long as they receive treatment and adhere to their care plan.
"Most patients end up becoming knowledgeable about HIV and controlling it. If they are committed to care, they can have long and prosperous lives. We have one patient with HIV who has been with us 27 years and is doing great," she says.
The case managers see their patients every time they come back to the clinic. They assist with booking appointments and enter the patient appointments on the case management calendar to be sure they see the patients. In some cases, they accompany the patients into the examination room. "They help them navigate the system and learn how to access the care and assistance they need," she says.
Helping patients adhere to their medication regimen is a big part of the case manager's job. "Every patient is different. The medication that works for one person might not work for another. When patients experience side effects, the case managers work with providers to find alternatives," she says. Some patients who work at night need a different medication regimen from those who work during the day, she points out. "The case managers work closely with the patients and the providers to make sure each patient's medication regimen meets his or her needs," she says.
Unemployment is a problem for some HIV patients. "Many patients want to work but are limited as to what they can do because of their illness. These patients need a lot of assistance from case managers and social services to meet their needs," she says. The case managers work with social workers at the clinic to arrange housing assistance, meal deliveries or access to food banks, and other community programs that provide support. "When patients' social problems are addressed, treatment adherence is easier," Ruggiero says.
They help appropriate patients enroll in substance abuse programs and, if they are eligible for funding, help them find a treatment facility that offers a sliding fee scale.
All of the clinic's mental health practitioners are given HIV training. "We have a strong mental health component at Open Door. We try to get all patients infected with HIV to have at least one mental health evaluation a year," she says.
The patients stay in case management as long as they are being treated at Open Door. If they move away, the case managers help them find a provider in their new community.
Source
For more information contact:
- Andrea Beltran Ruggiero, HIV Director, Open Door Medical Center, Ossining, NY. Email: [email protected].
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