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

1. Primary Healthcare and Chronic Conditions: A Health Worker’s Perspective Dr. José M. Zuniga, President Care and Treatment for People with Chronic Conditions High-Level Satellite Meeting – AIDS 2012 Sunday, 22 July 2012

2. HIV Age-related comorbidities Comorbidities = hypertension, diabetes mellitus, hypothyroidism, CVD, bone fractures Guaraldi G et al. Clin Infect Dis. 2010; 53(11):1120-1126

3. 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 Lab Tech CHW Peer Educator MCH Specialist Social Worker

4. Task shifting Writ large Task shifting II Task Shifting I Non-Physician Clinicians (clinical officers, health officers) Task Shifting III Registered Nurses & Nurse Mid-Wives REGULATION Supervision, Delegation, Substitution, Enhancement, Innovation Enrolled Nurses Doctors Nursing Assistants & Community Health Care Workers Task shifting 0 Specialized Physicians Task Shifting IV Expert Patients Courtesy of Seble Frehywot, MD, MHSA

5. QI StrategY EFFECTIVENESS:FINDINGS from a Review of Diabetes Care Shojania KG et al. JAMA. 2006;296:427-440

6. 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 PHC and prevention

7. Quality measures • Use of quality measures is an important driver to optimize chronic disease management • HealthQUAL International, HRSA HAB Core Clinical Competencies