Date of Report: 05/2005
Source: National HIV/AIDS Clinicians' Consultation Center
To help providers understand the complex issues related to managing HIV, patient-specific clinical consultation training activities (Level IV) often use interactive learning techniques. The NCCC has developed clinical consultation tips based on experiences from the HIV Warmline, PEPline, and the new Perinatal Hotline. NCCC faculty members apply these elements in telephone consultation, but they are applicable to on-site chart reviews, email questions, and curbside chats. Tips for Effective Level IV Clinical Consultation 1. Rapid Needs Assessment A successful rapid needs assessment should be able to:  | Identify the question |  | | Identify the interest/motivation in enhancing HIV skills/knowledge base | | | Identify the providers role in care of the patient | | | Identify the AETC faculty members role in assisting the provider A rapid needs assessment is used to clearly define the question and discuss the options. | |
2. Question behind the Question In the Level IV provider-driven approach, simply answering a question may not fully achieve the goal of an AETC consultation. For example, when a Warmline caller asks about the risk of anemia associated with didanosine (ddI) therapy, NCCC faculty consider additional questions beyond providing the incidence of anemia associated with ddI therapy: | Why is the clinician worried about anemia in the patient? | | | Is the patient taking other medications that might significantly contribute to anemia such as zidovudine (ZDV or AZT) or sulfamethoxazole (TMP/SMX)? | | | Has the clinician done the appropriate workup for HIV-related anemia, ruling out opportunistic infections or other conditions that might contribute to anemia? | |
Addressing the initial question and including considerations for additional questions effectively enhances the consultees HIV care skills and knowledge base. These skills are relevant to the case at hand and applicable to future patients. 3. Options not Answers Choosing initial ARV regimens, interpreting genotypic information, and constructing salvage ARV therapies are among the most common HIV Warmline questions, and there is rarely one single answer. Therefore, the NCCC faculty train clinicians to consider the advantages and disadvantages of different treatment options so the provider can make the best clinical choice for the patient. Offering options instead of answers enhances the providers understanding of the patients condition and increases the consultees confidence in his or her care and knowledge of HIV therapy options. Although understanding these three elements is essential to effective Level IV training, the application and implementation can be challenging. Achieving a level of comfort with these elements often requires training and skill development. For more information about the consultation training opportunities available, please visit the NCCC website: www.nccc.ucsf.edu, or contact Cristina Gruta, PharmD at cgruta@nccc.ucsf.edu. | 
