Rural Models of Care in Appalachia Portsmouth City Health Department Care

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Rural Models of Care in AppalachiaPortsmouth
City Health Department Care Prevention Clinic
Portsmouth, OhioChristy Sherman, RN,
BSNRaylene Maloy, RNAugust 2006
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History of the Portsmouth City Health Department
Care Prevention Clinic

• In Autumn 2004, the previous grantee lost their
  HIV/AIDS Physician and was no longer able to keep
  the grant. Discussions began to move the grant
  to another facility.
• The Portsmouth City Health Department(PCHD) had
  an existing HIV Education and Testing Program
  (CTS) and Disease Intervention Specialist (DIS)
  Program.
• The PCHD began working with the previous grantee
  to transfer the grant to Portsmouth.

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Portsmouth City Health Department Care
Prevention Clinic

• Clinic opened in January 2005 and staffed with
  Board Certified Infectious Disease Physician.

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Clinic Growth

• In the coming months, clinics opened in
  Chillicothe, OH Athens, OH Ashland, KY and
  Huntington, WV
• Each clinic has an assigned nurse case manager
  that is on the clinic premises a minimum of two
  times a month.
• All clinics have a physician who is Board
  Certified in Infectious Disease or Family
  Medicine.

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Care Prevention Clinic Service Area

• Our service area consists of twenty-four counties
  in the River Cities Area of Ohio, Kentucky and
  West Virginia.

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Objectives of the New Program

• Offer one-stop services
• Create a network of physicians so that patients
  do not have more than an hours travel to reach
  their physician
• To provide nurse case managers at all clinic
  sites
• To remove as many barriers to care as possible

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Services Provided by the PCHD-CPC

• Primary Medical Care through a network of
  contracted HIV/AIDS physicians.
• Nurse Case Management Services
• Referrals to other agencies
• Dental Care

• Vision Care
• Transportation Assistance
• Laboratory and Diagnostic Assistance
• Pharmaceutical Assistance
• Emergency Food Pantry

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Collaboration With Other Agencies

• The PCHD-CPC works closely with RWII in Kentucky,
  West Virginia, and Ohio
• The Nurse Case Managers are active members of the
  9C Title II Consortia.
• Often patients are seen in conjunction with a
  Title II Case Manager.
• By working closely with Title II, the patients
  receive greater services than either agency would
  be able to provide on their own.

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Collaboration with Other Programs

• Disease Intervention Specialist Services and HIV
  Counseling and Testing Services are available
  on-site.
• A reciprocal relationship has been established
  between RWIII and these two programs.
• A patient diagnosed through CTS or DIS is
  automatically referred to RWIII, and HIV and HIV
  affected individuals are referred to CTS and DIS
  in a similar manner.
• On-site partner/contact testing is available to
  all clients in the RWIII program.
• The nurse case managers are extensively trained
  in multiple DEBI programs, and they work closely
  with the CTS staff to administer Prevention for
  Positives programming.

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Challenges Presented by the PCHD-CPC Model

• Lack of support providers (i.e., dental, vision,
  mental health) who are willing to work with HIV
  patients.
• Large distances between contracted physicians
  creates a fractured system and decreases
  intra-network peer support creating difficulty
  developing a sense of cohesion.
• Lack of public transportation, low-cost quality
  housing, food pantries, and other support systems
  create treatment adherence problems for patients.

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Challenges Presented by the Service Area

• Appalachian health beliefs are unique in that
  they value self-reliance. Therefore, people do
  not come to the doctor for preventative health
  care or for minor illnesses.
• It is common for individuals to return to the
  region after moving away once they are no longer
  able to maintain their life in a metropolitan
  area. The Appalachian family will warmly accept
  them home, and provide support and assistance.
  Therefore, many of our clients entered our system
  in the latter stages of AIDS, and this increases
  the burden on the program.

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Challenges Presented By the Service Area

• Very little Title II funding is available in
  Kentucky and West Virginia.
• Long ADAP waiting lists create difficulties in
  obtaining medications in Kentucky and West
  Virginia.
• Ohio is implementing Medicaid Managed Care, which
  eliminates the enhanced reimbursement that many
  providers who treat HIV individuals receive.
• Three distinctly different Title II systems
  create navigation difficulties.

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Future Goals for the PCHD-CPC

• We are in the process of opening a Primary Care
  Clinic at the PCHD to serve the entire Portsmouth
  HIV and HIV affected community.
• Working on improving cohesiveness among the
  provider network.
• Investigating additional sources of funding to
  support additional client services.