PAETC Assists with the Closure of an Established HIV Care Clinic and Relocation of Its Patients

Way back in 1982 the Sonoma County Department of Health and Human Services, located 60 miles north of San Francisco, opened a clinic in Santa Rosa for the care of persons with HIV infection. By 2010 the clinic was delivering HIV specialty and primary care to over 500 patients. At its peak, the clinic employed seven part-time clinicians, one psychiatrist, nurse case managers, one health educator, one clinical pharmacist, counselors, one dietician, social workers and one outreach worker; many of the clinicians were PAETC faculty, based at the North Coast Area (NCA) local performance site (LPS). In that same year, due to the fiscal crisis and a predicted reduction in Ryan White funding, the County decided to develop a different model of care. Something had to be done.

The County formed a workgroup, which included the NCA LPS medical director, to develop a new approach to care, with input from multiple stakeholders. Retention in care was a key concern and focus of the planning. All along NCA LPS staff and faculty followed the process closely, providing support and technical assistance. Transition planning included developing a valid master patient list using billing records, Aries (the clinic's client-level tracking system) and an internal database developed by the LPS; this is just one example of where the AETC played a vital role.

Ultimately, the County decided to relocate patients and divide clinical care among three existing Federally Qualified Health Centers (FQHCs), with a central administrative group to coordinate the HIV care. In advance of the closure, a patient communication campaign was implemented, enabling patients to choose their future HIV medical home. Once patients made their choices, in care efforts involved tracking appointments and labs, informing clinicians and calling patients.

This brief description doesn't even begin to describe the complexities of the process, including how all patient records and clinical information would be transferred to new care sites. Information such as current and historic lab results, ARV history, resistance testing, medication lists, test results, and vaccination history, in addition to clinician tagged information of special significance, was fundamental to ensuring the continuity of high quality care. The AETC-designed database was critical in transferring this vital information from a paper-based system to new electronic health records.

The NCA LPS also played a crucial role in providing on-site trainings and information sessions at staff meetings, as well as ensuring clinicians will participate in their annual HIV update. In addition, the NCA LPS is investing considerable resources in long-term training of a key resident physician who is on track to becoming an HIV specialist.

While this story describes a painful but necessary change, given the current climate, it is not unique. The silver lining is that the AETCs are there to support the clinicians and protect the patients' interests with training and technical assistance to ensure high quality, accessible care. Below are the results of this tale.