- Email: [email protected]
AIDS Disease Management Programs
Guidelines & Outcomes
AIDS DISEASE MANAGEMENT PROGRAMS by Julia A. Rieve, RN, BSHCM, CCM, CPHQ, FNAHQ
O
ne of the newest and most exciting areas of case management (CM) is the disease management (DM) arena. DM embodies most of the founding principles of CM, and more case managers are making the transition into this specialty. For a DM program to be successful, it must meet the following criteria:
released last December, includes more than 420,000 Americans. According to the WHO, AIDS has surpassed tuberculosis and malaria as the leading infectious cause of death worldwide; more than 50 million people are infected with HIV. Of these 50 million people, an estimated 800,00 to 900,000 are living in the United States.1 With the advances in research and pharmacology, HIV patients are living longer with their disease, creating a definite need for DM programs.
• Feature a specialized disease focus • Address a high cost or utilization disease • Provide cost-effective, quality care • Offer patient education about disease issues and self-management • Facilitate a strong patient/case manger relationship • Identify early clinical and nonclinical management intervention issues
As of December 1999, a total of 61 AIDSrelated medicines have been approved for sale in the United States. A 1999 drug industry survey indicated that 102 medicines were in development for AIDS and AIDS-related conditions, including an HIV fusion inhibitor, 11 preventive vaccines, a new protease inhibitor designed to overcome resistance, and a gene therapy that infuses healthy CD4 cells into a person with AIDS.2
HIV/AIDS Resources Centers for Disease Control and Prevention www.cdc.gov World Health Organization www.who.int The Kaiser Family Foundation www.kff.org The National Institute of Allergy and Infectious Diseases www.niaid.nih.gov Chronimed, Inc., STATSCRIPT Division (800) 869-6593 www.STATSCRIPT.com Project Inform—information on approved and experimental treatments for HIV and opportunistic infections www.projectinform.org The Body—extensive information about HIV and its treatment
One of the diseases targeted by many organizations is HIV/AIDS. A DM program must address all the criteria listed above because this population is one of the most complex to manage given the multitude of drug regimens involved, its many stages, and the plethora of patient needs that must be integrated.
One company focused on providing DM services for chronic conditions, including HIV/AIDS, is Chronimed, Inc. Jim Halloran, MSN, RN, director of clinical programs for Chronimed’s STATSCRIPT Pharmacy Division, says, “Our pharmacy HIV program is best described as community-based specialty care. At each STATSCRIPT pharmacy in 28 cities, HIV-certified pharmacists and support staff deal with the individual patient and his or her specific situation and stay attuned to HIV resources in the local community. We maintain contact with patients and their physicians and work with community case managers as part of ongoing care.
essential. In many instances, the only health care professional the patient sees every 30 days is the pharmacist. We use this opportunity to identify potential problems early, before they become severe, with the goal of avoiding or minimizing negative impact on the patient’s ability to function.”
HIV/AIDS has entered the third decade of what many health care experts believe to be an epidemic. According to the World Health Organization (WHO), 16.3 million men, women, and children with AIDS have died since the disease was identified in the early 1980s. This figure,
“With combination antiretroviral therapy,” he continues, “many patients do well and thus visit their physician less frequently. This creates a situation in which initial symptoms may go unrecognized and untreated. In the context of chronic illness, prompt recognition is
He also says, “Our outcomes or success goals are constructed around the status of the patients, based on their individual situations. For those who are working, days lost because of illness are an important measure. For patients who may not be working, we focus on functional sta-
• Provide a strong management guideline approach based on current clinical methods • Tabulate and evaluate outcomes
TCM 38
September/October 2000
www.thebody.com Association of Nurses in AIDS Care (ANAC) www.anacnet.org
tus indicators, such as the ability to maintain independence in activities of daily living and perform usual activities like going to the gym or attending support groups. “As one would expect, many of the interventions provided by STATSCRIPT staff relate to managing the complex medication regimens used in HIV treatment. Examples include adherence planning and support, side effect management, and surveillance for potential drug interactions. In addition, because of the personal relationship with the patient, each staff member is well positioned to detect indications of emerging problems. Sometimes the pharmacy staff is the first to observe new symptoms, such as weight loss. He continues, “The nutritional evaluation and counseling services provided by STATSCRIPT’s registered dietitians are a key element in optimizing patient functional level and enhancing outcome. Examples of other interventions include patient education and counseling, physician consultation, or referral to a community resource. With HIV/AIDS, it’s critical to have a system based on an understanding of the complex effects of the disease. It’s also important to establish a personal relationship and understand the local scene. Through our focus on the individual patient, relationships with key HIV medical providers, and involvement in the local community, we blend high tech and high touch to optimize outcomes.” Disease-focused CM is an exciting arena for case managers to showcase their abilities. Case managers can provide tremendous value by continuing to develop interventions and documenting outcomes within an epidemic that increasingly affects people throughout this country and the world. ❑ References 1. Centers for Disease Control and Prevention. HIV/AIDS surveillance report: 11 (No 1). Washington (DC): The Centers; 1999. 2. Pharmaceutical Research and Manufacturers Association. Progress against AIDS promises to continue with 102 new medicines in development. 1999. Julia A. Rieve, RN, BSHCM, CCM, CPHQ, FNAHQ, is the founder and president of CQI, a health care management consulting services company in San Diego, Calif., specializing in utilization, quality, case, and disease management. She can be reached at (619) 226-4141; E-mail [email protected]; website www.CQIhealthcare.com. Reprint orders: Mosby, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146-3318; phone (314) 453-4350; reprint no. 68/1/110320 doi:10.1067/mcm.2000.110320 September/October 2000
TCM 39
AIDS DISEASE MANAGEMENT PROGRAMS by Julia A. Rieve, RN, BSHCM, CCM, CPHQ, FNAHQ
O
ne of the newest and most exciting areas of case management (CM) is the disease management (DM) arena. DM embodies most of the founding principles of CM, and more case managers are making the transition into this specialty. For a DM program to be successful, it must meet the following criteria:
released last December, includes more than 420,000 Americans. According to the WHO, AIDS has surpassed tuberculosis and malaria as the leading infectious cause of death worldwide; more than 50 million people are infected with HIV. Of these 50 million people, an estimated 800,00 to 900,000 are living in the United States.1 With the advances in research and pharmacology, HIV patients are living longer with their disease, creating a definite need for DM programs.
• Feature a specialized disease focus • Address a high cost or utilization disease • Provide cost-effective, quality care • Offer patient education about disease issues and self-management • Facilitate a strong patient/case manger relationship • Identify early clinical and nonclinical management intervention issues
As of December 1999, a total of 61 AIDSrelated medicines have been approved for sale in the United States. A 1999 drug industry survey indicated that 102 medicines were in development for AIDS and AIDS-related conditions, including an HIV fusion inhibitor, 11 preventive vaccines, a new protease inhibitor designed to overcome resistance, and a gene therapy that infuses healthy CD4 cells into a person with AIDS.2
HIV/AIDS Resources Centers for Disease Control and Prevention www.cdc.gov World Health Organization www.who.int The Kaiser Family Foundation www.kff.org The National Institute of Allergy and Infectious Diseases www.niaid.nih.gov Chronimed, Inc., STATSCRIPT Division (800) 869-6593 www.STATSCRIPT.com Project Inform—information on approved and experimental treatments for HIV and opportunistic infections www.projectinform.org The Body—extensive information about HIV and its treatment
One of the diseases targeted by many organizations is HIV/AIDS. A DM program must address all the criteria listed above because this population is one of the most complex to manage given the multitude of drug regimens involved, its many stages, and the plethora of patient needs that must be integrated.
One company focused on providing DM services for chronic conditions, including HIV/AIDS, is Chronimed, Inc. Jim Halloran, MSN, RN, director of clinical programs for Chronimed’s STATSCRIPT Pharmacy Division, says, “Our pharmacy HIV program is best described as community-based specialty care. At each STATSCRIPT pharmacy in 28 cities, HIV-certified pharmacists and support staff deal with the individual patient and his or her specific situation and stay attuned to HIV resources in the local community. We maintain contact with patients and their physicians and work with community case managers as part of ongoing care.
essential. In many instances, the only health care professional the patient sees every 30 days is the pharmacist. We use this opportunity to identify potential problems early, before they become severe, with the goal of avoiding or minimizing negative impact on the patient’s ability to function.”
HIV/AIDS has entered the third decade of what many health care experts believe to be an epidemic. According to the World Health Organization (WHO), 16.3 million men, women, and children with AIDS have died since the disease was identified in the early 1980s. This figure,
“With combination antiretroviral therapy,” he continues, “many patients do well and thus visit their physician less frequently. This creates a situation in which initial symptoms may go unrecognized and untreated. In the context of chronic illness, prompt recognition is
He also says, “Our outcomes or success goals are constructed around the status of the patients, based on their individual situations. For those who are working, days lost because of illness are an important measure. For patients who may not be working, we focus on functional sta-
• Provide a strong management guideline approach based on current clinical methods • Tabulate and evaluate outcomes
TCM 38
September/October 2000
www.thebody.com Association of Nurses in AIDS Care (ANAC) www.anacnet.org
tus indicators, such as the ability to maintain independence in activities of daily living and perform usual activities like going to the gym or attending support groups. “As one would expect, many of the interventions provided by STATSCRIPT staff relate to managing the complex medication regimens used in HIV treatment. Examples include adherence planning and support, side effect management, and surveillance for potential drug interactions. In addition, because of the personal relationship with the patient, each staff member is well positioned to detect indications of emerging problems. Sometimes the pharmacy staff is the first to observe new symptoms, such as weight loss. He continues, “The nutritional evaluation and counseling services provided by STATSCRIPT’s registered dietitians are a key element in optimizing patient functional level and enhancing outcome. Examples of other interventions include patient education and counseling, physician consultation, or referral to a community resource. With HIV/AIDS, it’s critical to have a system based on an understanding of the complex effects of the disease. It’s also important to establish a personal relationship and understand the local scene. Through our focus on the individual patient, relationships with key HIV medical providers, and involvement in the local community, we blend high tech and high touch to optimize outcomes.” Disease-focused CM is an exciting arena for case managers to showcase their abilities. Case managers can provide tremendous value by continuing to develop interventions and documenting outcomes within an epidemic that increasingly affects people throughout this country and the world. ❑ References 1. Centers for Disease Control and Prevention. HIV/AIDS surveillance report: 11 (No 1). Washington (DC): The Centers; 1999. 2. Pharmaceutical Research and Manufacturers Association. Progress against AIDS promises to continue with 102 new medicines in development. 1999. Julia A. Rieve, RN, BSHCM, CCM, CPHQ, FNAHQ, is the founder and president of CQI, a health care management consulting services company in San Diego, Calif., specializing in utilization, quality, case, and disease management. She can be reached at (619) 226-4141; E-mail [email protected]; website www.CQIhealthcare.com. Reprint orders: Mosby, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146-3318; phone (314) 453-4350; reprint no. 68/1/110320 doi:10.1067/mcm.2000.110320 September/October 2000
TCM 39