Primary Healthcare and Chronic Conditions: A Health Worker’s Perspective

Dr. José M. Zuniga, President

Care and Treatment for People with Chronic ConditionsHigh-Level Satellite Meeting – AIDS 2012

Sunday, 22 July 2012

HIV AGE-RELATED COMORBIDITIES

Guaraldi G et al. Clin Infect Dis. 2010; 53(11):1120-1126

Comorbidities = hypertension, diabetes mellitus, hypothyroidism, CVD, bone fractures

MCT DELIVERY OF INTEGRATED CARE

• METHOD: Retrospective analysis of clinical data sets on 2,647 patients at the CORE Center, Chicago, from 1997-1998

• CONCLUSIONS: “Our findings validate the multidisciplinary team model of HIV care, and suggest that health services that are tailored to the express needs of patients lead to better care and improved health outcomes.”

Sherer R et al. AIDS Care. 2002;14(Suppl 1):S31-S44

TASK SHIFTING WRIT LARGE

Task Shifting I

Task shifting II

Task Shifting III

Task Shifting IV

Specialized Physicians

Doctors

Non-Physician Clinicians(clinical officers, health officers)

Registered Nurses& Nurse Mid-Wives

Nursing Assistants

&Community Health Care

Workers

Enrolled Nurses

Expert Patients

REGULATIONSupervision, Delegation,

Substitution,Enhancement, Innovation

Task shifting 0

Courtesy of Seble Frehywot, MD, MHSA

QI STRATEGY EFFECTIVENESS:FINDINGS FROM A REVIEW OF DIABETES CARE

Shojania KG et al. JAMA. 2006;296:427-440

PHC AND PREVENTION

There is an important role for primary care practitioners in primary and secondary prevention chronic disease (e.g., CVD factors [weight control, physical inactivity, smoking, LDL/HDL/TG]) and, ultimately, tertiary prevention

Important consideration as we plan for implementation of TasP and PrEP

Use of quality measures is an important driver to optimize chronic disease management

HealthQUAL International, HRSA HAB Core Clinical Competencies

QUALITY MEASURES