Revamped HIV Clinic Sees Sharp Increase in Patients Health Improvements

January 16, 2007 — Reductions in acute emergency department visits, a drop in the rate of hospitalization and improved health outcomes for HIV-positive patients are being attributed to the John Ruedy Immunodeficiency Clinic's recent revamp. B.C.'s only clinic offering specialized and primary HIV care also continues to see significant increases in patient numbers. As of 2005, registered patients at the Centre's John Ruedy Immunodeficiency Clinic (IDC) increased 56%, to 15,239 from 9,785 in 2002.
“There are no signs of the IDC slowing down, mainly because we're filling a gap in services,” says clinic assistant director, Dr. Rolando Barrios. “We're serving a population who are not established enough to have a regular family physician.”

The IDC's recently completed redesign improved the clinic's ability to handle patient traffic and a wider array of care services. The clinic's multidisciplinary healthservices model underscores the variety of challenges faced by those living with HIV. The expanded IDC offers consulting expertise in psychiatry, diet/nutrition, addiction, hepatitis C co-infection, neurology, internal medicine and anal dysplasia. The additional services complement current consult expertise in HIV therapy, dermatology, infectiousdiseases and metabolic disorders. In the future, the clinic will also offer palliative and respite care, pain management and alcohol/drug counselling.

Patients can access the clinic on a drop-in basis, or by appointment if they wish to see a particular physician. The IDC benefits HIV patients in need of family physicians; active drug users who live outside the Downtown Eastside; and those recently discharged from St. Paul's AIDS ward without access to follow-up from a primary-care physician. The IDC also cares for patients who would normally have accessed St. Paul's emergency room.

In measuring outcomes from the IDC's redesign and new proactive approach, the hospital's emergency department burden has decreased and HIV patients' CD4 cell counts are increasing while viral loads are declining. CD4 cells are white blood cells responsible for coordinating much of the body's immune response and are one of the main targets damaged by HIV. Viral load refers to how much of the virus is in a patient's blood. Delivering more proactive patient care was a key influence in the revamp, says Barrios.
“To be proactive, we integrated a series of interventions, from improved information systems to the introduction of an interdisciplinary team,” says Barrios. “We alsointroduced the HIV primary-care database as a clinical tool to help providers monitor individual patients as well as practice outcomes.”

The primary-care database allows IDC staff to recall patients who are past due for a follow up (typically every three months), or those who may need to start on antiretrovirals or require immunizations, says Barrios.
“We have the capability to call patients and meet their health needs before they get sick, rather than waiting for them to come in with something like pneumonia and offering treatment then,” Barrios explains. “We want
to improve patient education and self-management strategies. We want patients to be more involved in their own treatment.”