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Anxious Annie and the Heartless Health Advisers Claire McCluskey & Maeve Cross Royal, Belfast GUM. Thanks for the Collaboration of:. Suzanne Gray Senior Health Adviser Angela Dorrian Clinical Psychologist/Supervisor GUM staff Belfast Annie. Introduction: Ideas, Process and Conclusions:.
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Anxious Annie and the Heartless Health Advisers Claire McCluskey & Maeve Cross Royal, Belfast GUM Belfast Health Advisers SSHA Conference 2008
Thanks for the Collaboration of: • Suzanne Gray Senior Health Adviser • Angela Dorrian Clinical Psychologist/Supervisor • GUM staff Belfast • Annie Belfast Health Advisers SSHA Conference 2008
Introduction: Ideas, Process and Conclusions: • Annie’s story • Timeline (Assessment/History) • What we did • What was more/less helpful • Interventions: Cards, Leaflet • Communication- Collaboration & Consistency • What happens next? Belfast Health Advisers SSHA Conference 2008
Audit 2007/2008 • 21 Anxious patients in 1 year • 17 Male : 4 Female • One third attended three or more times • Over half phoned at least twice Belfast Health Advisers SSHA Conference 2008
Assessment • Annie 28, Born N Ireland • 10 months ago Annie Kissed a man whose mum was said to be HIV +ve • Total: 5 lifetime partners • Married to Phil x 3 years • LOSP: 7 years ago • Blood transfusion locally, 2 years ago post ectopic • HIV risk assessment no other risk Belfast Health Advisers SSHA Conference 2008
Card Belfast Health Advisers SSHA Conference 2008
Chapter 1: Claire • HIV test only • Seen with husband • Annie declined antenatal HIV • “Reassurance doesn’t last” • “what ifs” re negative test Belfast Health Advisers SSHA Conference 2008
Chapter 1 • ? confidence (ectopic) • Support? • Patient returned in person • Urgent test-attended for result-Negative • Showed result • Began card Belfast Health Advisers SSHA Conference 2008
Chapter 2. Two Weeks Later: Suzanne • Annie phoned • Had read on internet about unreliability of tests • Reassured re risks & accuracy of tests • Referred again to GP for support • Checked out main support • Card completed Belfast Health Advisers SSHA Conference 2008
Chapter 3. Two Weeks Later: Suzanne • Annie attended tearful, requesting viral load test • Had been surfing the net! • Refused by HA & Dr • Reassured re accuracy Belfast Health Advisers SSHA Conference 2008
Who else knows? • Annie has a psychiatric nurse in the community • GP also aware of testing • Husband “frustrated” • Family aware • Filled card Belfast Health Advisers SSHA Conference 2008
Chapter 4. The Trouble with Testing: Suzanne • HIV result not on computerized lab results • Original fax not in notes • 2nd test taken • Sent urgently • Result in person and copy given to patient • Incident report • Original paper copy from lab put in notes • Completed card Belfast Health Advisers SSHA Conference 2008
Chapter 5. Two Days later: Maeve • Annie phoned requesting a viral load • Patient has trouble believing her negative result • Referred back to GP for avenues of emotional support • Documented in card Belfast Health Advisers SSHA Conference 2008
Chapter 6. Three Weeks Later: Claire • Patient attended requesting a viral load test • Very upset and tearful • Discussed support for anxiety • Told again re community services and (draft) anxiety leaflet given • HA offered to contact GP to link up support • Patient refused • Entry in card Belfast Health Advisers SSHA Conference 2008
Chapter 7. Helpful things • Brought case to group supervision (psychology) • Discussed: • Saying “no” • Consistency • Health Anxiety Model (Slavoski 89) • Pulling ideas together more formally in leaflet (draft to date) Belfast Health Advisers SSHA Conference 2008
Chapter 8. One Week later: Maeve • Conversation overheard by Maeve of medical ward Dr phoned re extremely anxious woman (Annie) who thought she had HIV-wanted her seen by GUM • Dr discussed with Maeve – awareness raising. • Patient seen by consultant in GUM • Annie requesting viral load test • Dr repeated test on condition he could contact GP who made contact with Annie. Belfast Health Advisers SSHA Conference 2008
Chapter 9: A Collaborative Approach • GUM staff involvement (consistent approach) • 3 Health Advisers • 4 Doctors • Clinical psychology (Supervision) • Information sharing and updating • Confidentiality – Risk & Opportunity in contacting other support patient has accessed e.g. GP Belfast Health Advisers SSHA Conference 2008
Lessons Learned: Further Collaboration Opportunity • Husband/Couple work • GP • Community mental health support CPN • Liaison with community groups so we can refer better • Consistency of approach as a GUM multidisciplinary team Belfast Health Advisers SSHA Conference 2008
Final Chapter: Positive Outcomes: • Lets us work within our competence • Give responsibility back • Signpost patients to useful support • Enhance team communication • Feel Okay about saying “no” • Cards • Supervision • Patient leaflet created Belfast Health Advisers SSHA Conference 2008
Happily Ever After…. ??... Belfast Health Advisers SSHA Conference 2008
