Primary Care HIV-Net GP’s contribution 14.09.2007
GP’s work in Belgium. Features • Individual doctors vs group-setting • GP acts as a first step and refers to specialist if necessary (multidisciplinary) • Preventive and curative care • Highly confidential relationship • Individual anonymous counseling • Homevisits possible • Working hours 24/24 hrs
GP’s work. Finances • Most patients pay cash per visit and get ¾ paid back by mutuality • 3th payment rule by OCMW or mutuality possible for migrants: patient pays nothing, doctor is reimbursed later • Other payment systems: health centres (few), Artsen zonder grenzen, and ‘Medicine for the people’
GP’s and STD’s/HIV • Every GP can offer and do a test for hiv/std’s • Lab tests are to be paid by patient (bloodtest, urinetest); partly reimbursed by insurance (mutuality/OCMW) • Follow-up and treatment can be done by GP in strict confidentiality
GP and HIV/STD test • GP’s detect 60% of hiv cases in Belgium • Screeningstest via private lab or via IMT • Hiv test = STD test (blood and urine sample) • Informed consent • Pre- and postcounseling (VCT)
GP’s-HIV-Network • Horizontaly (general practitioner’s Antwerp) • Verticaly (patients/ sensoa/ ITM-ARC/ hospital/ university/ helpcenter/ ...) • Peer review • Productinfo • Update hiv/std
GP’s and HIV-Net • Since 1999 GP’s (15) in Antwerp meet 3x/yr for updating/ intervision • Speakers from all levels are invited at regular bases • Different groups of society are highlighted • Hiv an std knowledge is updated • Only a small amount of GP’s is interested!
HIV-Net and HIV-SAM • In 12/2003 the HIV-SAM project has been introduced in Hiv-Net meeting • Leaflets were made and explained to GP’s of the network • GP’s went back to their practices with open attitude for counseling and testing • Few patients consulted hiv-net members
Conclusion • To pay cash at the GP’s office is a barrier • To pay the lab separately is a barrier • GP’s have good knowledge on prevention and VCT but people ask more for curative care
Suggestions • Distribute (anthropological) knowledge of African culture and health beliefs among GP’s in their magazines/updating circuit • Administration of 3th payment rule asks more time, but can be encouraged • Private labs to be sponsered for hiv-tests to reduce the cost for the patient?
Precounseling • Open questions, not convicting, discrete • Clearing up fear(s), in dialogue! • Listening in an active way (reflecting, making feelings and thoughts clear, summarize • Make an inventary of barriers, intentions and choices, with respect for the proces of the patient
Postcounseling • Prepare yourself: timing!, own fear ? • Introduce with ‘I message’ • Tell the bad news shortly and immediately. Give time and space !! • React/reflect on emotions (‘I see that...’), reflect, mirror,... . Take time! • Give more explication on the result if necessary (shortly) • Make a summary and a plan (24 hrs); confidential/professional persons to inform?