Integrating care between Addiction and HCV Services Jan Tait Ninewells Hospital, Dundee - PowerPoint PPT Presentation

1 / 25
About This Presentation
Title:

Integrating care between Addiction and HCV Services Jan Tait Ninewells Hospital, Dundee

Description:

Literature review revealed reasons for non attendance (poor relationships with ... Focus of study changed to reasons for attendance ... – PowerPoint PPT presentation

Number of Views:56
Avg rating:3.0/5.0
Slides: 26
Provided by: jan8152
Category:

less

Transcript and Presenter's Notes

Title: Integrating care between Addiction and HCV Services Jan Tait Ninewells Hospital, Dundee


1
Integrating care between Addiction and HCV
ServicesJan TaitNinewells Hospital, Dundee
2
(No Transcript)
3
Problems with specialist service
  • High non -attendance rates (50 -60)
  • Long waiting times
  • Poor communication between primary and secondary
    care and addiction services and HCV specialist
    service
  • Inflexible referral to specialist Centre
  • Ineffective follow up
  • One clinic in main hospital

4
Perceived reasons for lack of referral and
attendance
  • Perception of clinic
  • Lack of knowledge of illness
  • Unsure reason for referral (no symptoms
  • On going drug problems
  • Lack of Treatment
  • Myths about treatment
  • Clinic Waiting Times

5
Tayside Hepatitis C Managed Clinical Network
  • Established Jan 04
  • Health Board Area
  • Dundee, Perthshire, Angus
  • Primary and secondary care
  • Staff from
  • Specialist HCV service
  • addiction service
  • prison service
  • social services

6
HCV Managed Care Network
  • Establish reasons for non-attendance
  • Arrange meetings with Stakeholders -Drug workers,
    GPs, Prison Staff, Ante-natal staff and GUM
    clinic
  • Design new referral pathway to include
    Multi-professional referral
  • Provide educational sessions
  • Create accurate database
  • Develop nurse led service and outreach services

7
Service redesign
  • Referral extended to all health care
    professionals caring for patients with Hepatitis
    C (drug workers, prison nurses, midwifes, socials
    workers, homeless workers)
  • Nurse led clinic weekly (first appointment)
  • Establish outreach clinics
  • New referral pathway

8
(No Transcript)
9
Service redesign
Noranside Prison Outreach clinic
Outreach clinic Arbroath GP practice
Nurse led new clinic at Ninewells Hospital
Perth Prison Outreach clinic
Outreach clinic Perth Drug Problem Service
10
Interventions to increase attendance
  • Send copy of appointment to referrer (drug
    worker, social worker, prison nurse)
  • Key worker explains need for referral
  • Key worker accompany patient
  • Send DNA letter to patient
  • Contact by phone, text, e-mail
  • Rebook appointments when referrer or client
    contacts service
  • Send reminder letters/text

11
Outcomes
  • Increase in referrals
  • Increase in attendance
  • Increase in numbers treated
  • 892 no referral

12
Establishing a database
  • Information on
  • individuals who are HCV positive in region
  • number who should be referred
  • number who had been referred
  • number who have attended
  • number who have been treated

13
Outcomes of database
  • There were 1767 hepatitis C antibody individuals
    identified.
  • 1331 (75.3 ) were male.
  • (73.1) tested were aged between 16 and 39.
  • 447 (25.2) of tests GP practice,
  • 364 (20.5) in Prison service
  • 328 (18.5) in hospital.
  • Follow up HCV PCR was available on 1243 and 928
    (74.6) were positive.
  • Transmission risk was known in 1304 of cases and
    in 1122 (86) this was injecting drug use.
  •  

14
Outcome of individuals not referred to specialist
clinic Total 892
15
137 in Tayside not referred
  • 67 (48.9) are in contact with local drug
    services
  • 6 (4.3) are currently in Prison
  • 6 (4.3) are under the care of the Mental Health
    Team.
  • 40 (29.1) had attended their General
    Practitioner in the last 2 years
  • 18 (13.1) had no contact with Health Services
    within the last 2 years.

16
Non-attendance
  • Decreased however still significant
  • Most non-attendance was clients from drug problem
    service
  • Study on reasons for non-attendance

17
Qualitative study
  • Semi-structured interviews (4075 mins)
  • 12 participants throughout Tayside
  • Literature review revealed reasons for non
    attendance (poor relationships with health care
    professionals, health low priority, poor
    knowledge regarding illness and treatment
    options, etc)
  • Focus of study changed to reasons for attendance
  • All participants had attended clinic at some
    point
  • Transcribed interviews examined to find common
    themes

18
Lack of individuals knowledge of HCV
  • Caused by Health care professionals lack of
    knowledge
  • Information given at diagnosis very poor
  • Confusion over HIV/HCV
  • No knowledge of treatment
  • Myths about treatment

19
Impact of health professionals lack of knowledge
  • Did not understand need for referral
  • Did not think disease serious / or fatalistic
    attitude
  • Importance of knowledgeable health care
    professionals

20
Stigma and isolation
  • Poor relationship with healthcare professionals
  • Not entitled to care and treatment
  • Would be judged because of drug use
  • Relationships with family and friends, did not
    want family to know diagnosis

21
Motivation to seek care
  • Positive influence of family and friends
  • Knowledge of health care professional
  • Encouragement by health care professional to seek
    care
  • Knowing someone who had been at clinic and/or
    taken treatment
  • Concerns about health, particularly in older
    individuals
  • Being a parent
  • Knowledge of treatment and outcomes
  • Continuing drug use would be a priority

22
Factors influencing access to care
  • Supportive health care professionals
  • Reminders, help with transport, moral support at
    clinic
  • Practical help, clinic nearby, knowledge of
    clinic, short waiting times
  • Outreach clinics not everyone liked clinic in DPC
  • Knowing that they would not be discriminated
    against

23
Outcomes of study
  • Improve information on HCV given at diagnosis
  • Dispel myths about treatment improve patient
    information
  • Improve education of health care professionals
  • Develop the positive benefits of supportive
    relationships with healthcare professionals
    particularly drug workers
  • Motivation of individuals to address health needs
    (stages of change).
  • Refer when at appropriate stage
  • Increase motivation to seek care
  • Implement other strategies to increase attendance
  • Liaison outreach nurse specialist

24
Conclusions
  • Integrating care between addiction services and
    HCV services improve outcomes
  • Managed clinical network assists with integration
  • Increase access for patients from Substance
    misuse services in Tayside
  • Increase numbers tested for HCV (blood spot
    testing, testing included in initial assessment
    and yearly if at risk)
  • Increase numbers in treatment

25
Thank you for your attention
Write a Comment
User Comments (0)
About PowerShow.com