COMMISSIONING
in the provision of services.
In order to allay concerns, close monitoring and regular reporting on key performance indicators (KPIs) for treatment and prevention need to be developed quickly. In support of this, there need to be efforts to improve dialogue between commissioners and third sector/voluntary sector organisations.
b) Primary care and other services
It is important to improve the quality of primary care for people with HIV and establish better interaction between HIV specialists and other community clinicians, in order to provide good quality patient-centred care.
The flow of communication between primary and secondary care can very often break down, leading to resources being wasted through duplication of services and a lack of understanding of the patient’s treatment programme. For instance, routine patient tests are often duplicated – GP surgeries may undertake blood tests to fulfil QOF objectives, replicating work undertaken by specialists and wasting patients’ time.
Owing to limited understanding of HIV, GPs can often refer patients with HIV back to their HIV clinic for unnecessary reasons. To try to develop greater GP involvement, various models have been piloted. Consideration needs to be given to what elements of best practice can be learnt from these models and how this might then be applied and replicated nationally. We hope in particular that patient access to their GP record and other medical records could facilitate communication and improve the quality of care.
c) HIV and the ageing process
Managing care for the older person is generally complex because the ageing process presents
The need for effective long-term condition management is becoming an increasingly relevant component to caring for those living with HIV. The best models and approaches to fulfil this are still a matter of debate. Research and engagement in this area will require the active sharing of information, insights and findings between different groups, supported by effective commissioning of services and appropriate service design. Multi-disciplinary team involvement is critical to this, allowing for HIV clinicians to work together with specialist clinicians and with geriatricians in helping patients manage common co-morbidities.
d) Mental health
Many older people living with HIV report concerns over their mental health as a result of particularly high levels of stress and anxiety associated with living with a life-threatening condition, public stigma and frequent complex information change.
Advances in clinical practice mean that there is now high-quality care for the physical management of HIV, but it is the provision of HIV-specific mental health and social care support that requires further development.
This is about funding, but also identifying and accepting that this kind of support is required. Specific support programmes can then be developed with appropriate funding. Key elements of support programmes need to
Matt James FOR MORE INFORMATION
W:
www.2020health.org/2020health/ Publications/Publications-2014/
HIV.html
national health executive Nov/Dec 14 | 43 Julia Manning
physical, psychological and social challenges. Whereas a bone fracture in a younger person may not present too many added complications, in someone older it can lead to dehydration, bruising, pneumonia and immobility. This restriction of activity can then lead to feelings of isolation, depression and loss of confidence. An already challenging situation is made more complex in the case of an older person living with HIV.
include access to mental health services and therapies and the space and opportunity to meet with others for peer support.
e) Care provision
Care service providers need to be better in- formed and equipped to help care for those liv- ing longer with HIV. Many providers have not needed to respond to the care needs of the older person living with HIV so they currently have very limited experience. Skills and training therefore need to be improved in this area. This provides a strategic opportunity to establish what a good care provider should offer in terms of services and facilities for all those suffering with long-term conditions.
Underpinning all of this is the need for any refashioning and redesign of services to focus on empowering older patients to live a life with HIV. Rather than providing for older patients, services now need to work with the patient, balancing good HIV treatment with treatment for co-morbidities and integrating social care support. The voice of this group has effected many changes and we must harness this not only to improve the quality of later life for those with HIV, but for all older people.
Full references and sources for this article are available at
www.nationalhealthexecutive.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100