WASHINGTON — Juggling the needs of HIV patients during planned visits can stretch the time management skills of any health care provider.
“If we rely on memory alone for everything we're supposed to do for a patient, we will forget 30%–40%,” Dr. Donna Sweet said in a workshop at the Ryan White CARE Act clinical meeting.
Dr. Sweet breaks down the HIV patient's planned visit into three components: HIV care, social and behavioral care, and general health maintenance.
The planned visit is first and foremost an HIV visit, said Dr. Sweet, an internist and professor of internal medicine at the University of Kansas, Wichita. “You have to review what drugs they are taking, and check their viral loads, and make sure that their HIV is as well controlled as possible,” she said.
To help providers remember the HIV-specific information they need to address with patients, Dr. Sweet and her staff designed a Patient Assessment Stamp—an actual ink stamp—that stamps a list of items on each HIV patient's chart.
The Patient Assessment Stamp lists a total of eight items: patient education, nutritional assessment, medication adherence counseling, risk reduction counseling, tobacco evaluation, mental health evaluation, substance abuse evaluation, and oral health evaluation.
Although all eight items are important, Dr. Sweet emphasizes medication adherence counseling in particular and makes it a priority for her medical residents when they work with HIV patients.
The assessment stamp prompts residents to ask patients what medications they are taking, whether they understand why they are taking the drugs, and how many pills they have missed in the last week.
Dr. Sweet also stressed the importance of tobacco evaluation in HIV patients.
“The smoking cessation message is as important as the risk reduction message for HIV patients,” she said. “When it comes to the health of my patients, I don't want them spreading the disease, but smoking may be what kills them, based on what we know about lung cancer and the increased risk in HIV patients.”
Oral health is included on the HIV assessment stamp because it is an important, but often-neglected, aspect of HIV care, Dr. Sweet said.
“Oral hygiene in these patients can be awful, especially if they get dental abscesses and get infected,” she said. Offering toothpaste or toothbrushes to HIV patients at planned visits can be a springboard into the second—social and preventive—component of the visit, she added.
The social and preventive component of the planned visit includes asking whether patients have jobs or homes and whether they are trying to avoid spreading their disease.
The third component—general health maintenance—includes the basic care that every patient needs, and this list is expanding as HIV patients live longer.
“My oldest HIV patient is 75 years old,” Dr. Sweet noted.
But general health maintenance will be postponed if patients are acutely ill when they arrive for planned visits, Dr. Sweet emphasized. “Sometimes you have a patient who has been ill for 2 weeks, but he knew he had a planned visit, so he just waited to see you.”
In those instances, Dr. Sweet treats the acute problem and reschedules the regular planned visit for as soon as possible within 1–2 weeks to address the HIV issues.
“The patient assessment stamp is a process that helps us ask questions and not miss important things, such as whether they have been using drugs,” she said. A stamp—or any type of checklist on a chart—reminds every provider what to ask HIV patients at every visit. “It may not always save time, but it improves the overall quality of care, in my opinion,” Dr. Sweet said.