HRSA SPNS Grantee Conference Call
Participants: Christopher Johnson & America Jones, Charles
Smith, Elias Cantu, Yolanda Cantu, Sandi Duggan, Kari Maier, Veronica
Salcido-Harding, Michelle Valverde, Yvonne Roacho, Steve Trujillo, Ken Burton, Tony Estrada, Maria Luisa Zuniga, David Barney, Tim
Brittingham, Betty Duran, Herman Curiel, Robyn Schulhof, Adan Cajina, Ledia
Martinez, Michael Tarter, Kurt Organista
Project
Reports:
Arizona:
Trainings: The AZ AIDS ETC, Robert Castrillo is working
with Cochise County Health Department on HIV Grand Rounds for Cochise County
health care providers.
The AZ AIDS ETC is working
on developing 12 core HIV/AIDS training modules that will be delivered to the
clinic staff at the CHCs. The modules
will be reviewed by Dr. Goldsmith to complement the training for
physicians. Training will be scheduled
quarterly for the core modules and CHCs may still request additional training
as necessary. Steve advised that when
these are finalized, he will have them posted on the Centro de Evaluación web
page for review by all projects.
Out Reach Activities: Yuma County – The Yuma County Health
Department (YCHD), Puentes de Amistad conducted outreach and condom
distribution at local nightclubs during the week of Valentine. The promotoras of Puentes de Amistad and
Campesinos Sin Frontera continue their outreach to migrant farm workers. Gabby Leon (YCHD) rescheduled the training
of the promotoras of Campesinos Sin Frontera due to the death of Flor’s
father. Upon Flor return to work Gabby
and Flor will contact the foremen of the farms to work on securing the use of
the buses used to transport the migrant farm workers as a counseling and
testing site.
Santa Cruz County –
Platicamos Salud handed out condom roses in Nogales and Rio Rico for
Valentine’s Day. Condoms were left at
the truck stops along with HIV information pamphlets and prevention kits.
Platicamos hired Ana Dutram
to replace Jose who left to start cadet training for the police department.
Cochise County – Cochise
County Health Department (CCHD) is working with Chiricahua Community Health
Center nurse Elizabeth to train the CHC’s two promotoras on HIV outreach. The Chiricahua Health Center has signed
their contract for year two.
Dissemination
Activities: The project is working with
the planning committee and HRSA on the US-Mexico HIV/AIDS Border
Conference. Heather Baldwin and Pam
Duffy of the Pacific AETC as committee members will assist in putting together
the Peer Review Committee for abstracts.
Sudhir at OU is constructing the conference web page that will be
located on the El Rio website (www.elrio.org).
Project Enrollment: The project has enrolled six additional
patients in Cochise, Santa Cruz and Yuma County. The total number patients enrolled to date is 62.
Local Evaluation: Impact Consultants with the project
coordinator revised the Health Provider Assessment, Physician Self-Assessment
and the Karnofsky Scale. Developed was
a local change form all forms will be distributed and discussed at the March
meeting of the collaborators.
Tony Estrada advised that he
submitted to abstracts in behalf of the SPNS project for presentation at the
International AIDS Conference in Spain.
California:
1. New mechanism for data
processing: San Diego was interested in trying out the fax-in option presented
by Centro. We will use this process as a second option to web-based data entry.
All the technical support provided by Tim Brittingham has been MOST helpful and
appreciated.
2. The local evaluation team
is planning to host a re-training for data collectors in March. This meeting
will provide an opportunity for QA review for data documentation, review of any
new data collection forms, and review QA issues for filling out forms so that
they are appropriate for faxing.
3. We are still a little
backlogged on data entry, but hope to be up to snuff by the end of the month.
El Paso:
John Wiebe is lecturing
class today and Tony Chavez will be at an off-site meeting, therefore they will
be represented by Christopher Johnson and America Jones.
1. Data collection is
continuing, and our new, aggressive patient
recruitment
strategy is paying off. Our numbers are creeping back up, and
we
are once again doing more than two interviews per day, on average.
2. We are holding
biweekly project meetings in conjunction with the Monday
conference
calls.
3. HIV testing and counseling is an on-going
effort – last week identified three (3) new positive cases.
4. Project currently employs three case managers and two nurses on
staff.
5. Case study presented – issue was a male
client who lives in Sunland Park, NM, obtains HIV services from Centro de Salud
Familiar La Fe in El Paso, and encountered problems in accessing ADAP in
Texas. Texas policy is that to be
eligible for ADAP, you must have a Texas driver’s license, the client had a New
Mexico license. They were able to
resolve by determining that New Mexico will provide ADAP to clients with
prescriptions from Texas physicians.
Project expressed concern that Texas/New Mexico border clients often
prefer to access services in El Paso versus driving to Las Cruces which is 45
miles away. Kari Maier advised that one
of their collaborating CHCs has clinic hours in Anthony and Sunland Park
(Clinical de Familia) and clients can access services through this clinic. Kari recommended that both projects may need
to work on issues of communication that will enhance service delivery for both
agencies.
New Mexico:
q Programmatic: (Veronica)
·
NMAETC provided a
training session with Ben Archer Health Center on January 30th: Dr. Bob Munk presented an HIV Update
q Local Evaluation: (Michelle)
o
Michelle and Yvonne are
working on the Outreach Code Book to include all outreach
modules.
o
Yvonne has initiated a
“HRSA Code Number” for Outreach Contacts that include the site, fiscal year,
contact number (for tracking), and the gender code.
o
Preliminary trainings
set for March 7, 2002 with the Promotores for training on the new modules
o
Yvonne recently
completed 3 out of 4 of the time two follow-ups (Quality
|
OUTREACH: |
Individual Outreach |
|
(91
= FY2) |
262 181 |
|
|
Group Outreach |
||
|
69 4 0 16 |
|
|
Total number of contacts
(individual & group) |
307 |
|
|
IN-HOUSE: |
Number of interviews and
data collected on HIV+
Clients:
|
52 |
Harlingen:
Two key issues for Proyecto
Juntos:
under
way
PROJECT
DATA COLLECTION ACTIVITIES
·
Project
data collection activities continue at a steady pace. As of February 6, 2002, there are 147 records in the
Local Database.
·
As
of February 14, 2002 a total of 258 forms have been
entered in the multi site database:
74 Demographic A Project
Implementation Date: 030101
73 Lifestyle B Project
Implementation Date: 030101
73 Risk Factor D Project
Implementation Date: 070101
16 Quality of Life
E Project Implementation Date: 070101
14 Barriers to
Care F Project Implementation Date: 110101
08 Client
Satisfaction G Project Implementation Date: 070101
LOCAL EVALUATION SYSTEM
LEVEL INTERVENTION ACTIVITIES
·
Routine
evaluation contact (e-mail and/or telephone call) with Project physicians and
nurse care coordinators to systematically assess needs and satisfaction with
the Juntos Project process reveal the following:
1.
Continued expression of
dissatisfaction regarding protection of time, with adverse consequence, to
provide HIV primary care. As one partner physician recently stated, “not only
am I not being paid, my productivity has been affected.”
2.
Cross coverage has
emerged as a physician concern.
3.
Continued expression of
dissatisfaction with not receiving feedback regarding efforts made to resolve
the protection of time issue. Although
there has been repeated discussion of this issue at partnership meetings. Project staff would like to see this issue resolved.
4.
On-going incidents of
‘no shows’ at partner sites are disruptive to the overall operations of the
community health centers.
·
Critical Incidents
Negative –
One partner physician
reported an increase in Project work demands with a decrease in incentive for
continued participation (they feel that they continue to be “dinged” because of
project activities such as training, project meetings, and patient care). This
is affecting the bottom line, i.e., not eligible for annual for bonus for 2nd
year in a row. The physician accepted
an HIV referral outside the SPNS Project network, which came during off duty
weekend hours. In addition, the case warranted immediate hospitalization to
include intense follow up. [This is example of a cross coverage problem.]
Negative - On February 15, 2002 via e-mail, the Brownsville Community
Health Center partner physician informed Project and local evaluation staff of
his intent to resign as SPNS Project physician. He stated that he would arrange
for proper transfer of care for his HIV primary care patients to VAC in
Harlingen. He further stated that he
would continue to provide medical care until the patients have been assigned a
new physician. Charles Smith that the doctor
rescinded this decision in a conversation between the doctor and Charles
Smith.
Positive - January 2002, Dr. Gary Sinclair, Medical Education Director
at TOAETC coins the term "newly evolving Valley HIV Mafia." He states
that in his role as trainer, his goal is to promote independence where the
partner physicians begin to view each other as a resource versus reliance upon
a geographically distant medical ‘expert.’ He also provided ideas for
addressing the protection of time issue, more specifically whereby the SPNS
project could encourage the partner physicians to join forces, share ideas and
experiences in a monthly Journal Club or Case Conference format. His hypothesis
is that if the doctors begin to view themselves as part of a “specialized club,”
together they will solve problems encountered in their SPNS work. For example, they will work to solve cross
coverage for admissions, off duty and vacation time, will cease to view each
other as competition, will become a powerful unified voice to increase service
for their patients and start viewing HIV care not as an additional burden, but
as a "perk" of their practices.
Dr.
Sinclair’s thoughts are based on the premise that 12 years ago, similar
situations occurred in the big cities. He suggests that since the Valley's
epidemic is about 12 years behind the big city epidemics, it makes perfect
sense that this is the process through which the Valley doctors would be going
through now.
Positive
- There has been an increase in
the numbers of electronic HIV specialty consultations between the partner
physician in Pharr and the HIV specialist.
Previously there were no consultations to report.
Negative
– Lack of technological
resources at two partner sites make long distance HIV specialty electronic consultation
seemingly difficult and at times not possible.
Two Project physicians do not have access to computers in their offices
or nearby, those computers available are severely outdated and fax machines are
overrun by other CHC personnel.
OTHER EVALUATION ACTIVITIES
·
Local
evaluation disseminates information provided by Dr. Gary Sinclair for use by
partner physicians. The following
informational websites were forwarded to partner physicians in Pharr, Eagle
Pass, Brownsville and Harlingen: Merck Medicus website, (merck.com) and http://www.pocketmedicine.com
·
January
18, 2002 - submitted evaluation activities summary to Project Director for
inclusion in the Semi annual Progress report.
·
This
period, the bi-monthly UTHSCSA local evaluation team meeting generated the
following:
1.
Updates
to local evaluation data manual are underway and include new process for
collecting a full intake form for updates, with no changes designated by
choosing a NC (no change) box.
2.
The local
evaluation Change Form is under development with variable fields that reflect
the programmatic changes that most occur; IE, death, change of address, client
closure or lost to follow up. The
Change Form will also capture pregnancy status. Discussing how to best track
changes in HIV primary care site.
3.
The
group agreed to collect variables 1-12 on the local Intake and Demographic
Characteristics Form for the purpose of studying the sub component of people
who opt out of participating in the SPNS Project. Careful analysis of the 10-15% that do not consent will be done
in order to determine whether this percentage holds constant over time and to
explore the hypothesis that this sub population of people are receiving private
medical care.
4.
VAC
program caseload has had 7 active clients who chose to become pregnant during
the past year. This number is higher
than usual where historically the average has been from 3-4. Local evaluation
plans to conduct qualitative interviews with the sub population of pregnant
women for the purpose of learning about birth/health outcomes and satisfaction
with care in the lower Rio Grande Valley and in Eagle Pass.
5.
Select
variables applicable to newborns will be completed on the local Intake and
Demographic Characteristics Form.
6.
Local
evaluation has begun work on development of mechanisms to track ‘no show’ rates
for HIV primary care appointments at partner CHC’s. Efforts by Project staff
and Project physicians will be aimed at significantly reducing the no-show
rates at partner CHC’s via replication of the ‘Best Practices Model’ identified
in a recent Mental Health Mental Retardation report.
Centro
de Evaluación:
a. Qualitative Study (Betty) A consultant has been hired to conduct the
key informant interviews at all five project sites. Presently, we propose to implement the interviews in late
March. The Centro de Evaluación will
send projects a protocol for client selection.
Additionally, each project will
contacted to discuss possible date for key informant interviews.
b. Grantees Meeting in DC is
scheduled for July 25-26, 2002 at the Parklawn Building in the Potomac
Conference Room. Lodging is being arranged
through the Doubletree Hotel which approximately eight blocks from the Parklawn
building. Transportation is available
on a shuttle which leaves the Metro station every 10 minutes and costs 25 cents
each way. Metro is less than a block
from the Doubletreee Hotel. Betty need
to provide the hotel with a list of participants. Once the block of rooms is confirmed, she will sent the booking
information to all participants so that they may guarantee their reservation.
c. Data update - Tim
HRSA
Updates: No updates
at this time.
Other:
Steve asked for an update on
AETC evaluation and Medical chart extractions.
Betty advised that the grantees had decided that HIV medical training
evaluation was to be a local evaluation issue and that to support some
multi-site effort wanted to conduct a focus group/townhall meeting during the
grantees meeting to be held in DC. After
the San Diego Grantees meeting, HRSA and the Centro de Evaluación have held
additional discussion on the issue through which the scope of the evaluation
had been clarified. No final decision
has been made on how to proceed with this evaluation issue, but as a plan is
formalized, it will be presented to the grantees by Centro and HRSA staff.
Medical Chart extraction is
scheduled for September 2002. Presently
Betty is working on identifying two teams consisting of 3-nurses or medical
professional persons who could conduct the reviews at all the five project
sites. The budgets submitted by local
projects were estimated to be too low by Betty. She had developed an counter projection based on a team
approach. Both the local budget and
Betty’s new projection have been provided to HRSA for review and planning for
budget in YR-03.
Next Conference
Call: March 11, 2002 @ 10:30 am (CST)
Toll Free Dial-In Number
– 866-881-1338