El Paso SPNS Disease Management Model

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El Paso SPNS Disease Management Model

• Centro de Salud Familiar La Fe
• La Fe CARE Center
• Community Advocacy, Resources, and Education

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El Paso Team Members

• Tony Chavez, Administrator
• John Wiebe, Local Evaluator
• Christopher Johnson, Data Manager
• Ledia Martinez, Project Officer

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Project Location
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Centro de Salud Familiar La Fe
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Logic Model--Intervention
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Logic Model--Outreach
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Logic Model--Training
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SUMMARY OF CARE MANAGEMENT INTERVENTIONS
Jan.-Aug. 2001

• Care Managers (RNs) completed transition of 112
  clients to the Disease Management model
  bringing total caseload to 254 at the La Fe CARE
  facility (an increase of 78.8)
• 357 people were tested for HIV, with a
  return-for-result rate of 84 (or 299 persons)
  and a positivity rate of 16 (or 57 persons)
• In response to this volume, 7 additional staff
  members were trained in pre-test counseling and
  partner elicitation
• 42 clinic visits in July 2000 vs. 208 clinic
  visits in July 2001 (27 walk-in visits Dec 2000
  vs. 48 in July 2001)

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Needs Identified As A Result of Care Manager
Involvement

• Referral tracking mechanism (i.e., ophthalmology,
  radiology, dental, etc.)
• Response to abnormal/critical lab results
• Rapid response to failed clinic appointments
• Uniformity of all medical records
• Administration of all vaccines indicated by
  protocol (to include Hepatitis B vaccine)

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Personnel Challenges Identified

• LMSW/ACP difficult (if not impossible) to retain
  due to salary available and large case load
• Nutritionist who is bilingual is difficult to
  recruit
• Will attempt to contract rather than employ
• Care Managers are receiving nutrition training in
  the interim

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Evaluation Challenges and Solutions

• Dedicated data collection personnel
• Integration of care manager input

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Demographic Characteristics

• N112
• 87 male
• mean age 38 years
• mean time since diagnosis 5 years
• 97 White
• 90 Hispanic
• 56 preferred to answer in Spanish

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Sexual Orientation
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Education
Of the years of education reported, about half
took place in Mexico and half took place in the
U.S.
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Most Likely Exposure Category
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Employment Status
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More on Employment

• About half had been employed during the past
  year.
• 58 of those who were not employed were out of
  work for health reasons.
• Those who were employed missed an average of 17
  days in the last year due to poor health.
• 70 reported having no health insurance.
• 23 of those unemployed said they were looking
  for work.
• 20 of those who were not looking for work said
  that they were concerned about losing their
  benefits if they got a job.
• Average household income was 12,668

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Inferred Treatment Issues
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Emergency Room Utilization

• 38 reported using the ER for care in the last
  year, for an average of 2 visits.
• Very few of those visits were initiated by clinic
  staff.

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Depressive Symptomology

• Mean score on the BDI-II was 12.4 (Standard
  Deviation 10.8)
• Mean depression for English speaking clients was
  14.7 (std. dev. 11.1)Dysphoric range
• Mean depression for Spanish speaking clients was
  10.8 (std. dev. 10.3)Nondepressed Range
• Note a score of 20 or above would indicate Major
  Depressive Disorder (Dozois, Dobson, Ahnberg,
  1998)

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Adherence

• Of clients currently taking HIV medications, 74
  reported that they had not missed a dose in the
  past 3 days.
• For those clients that did miss a dose in the
  past 3 days, mean number of reported doses missed
  was 4.4 (Std. dev. 4.6)
• That is, they reported not taking their
  medication 27 of the time.