OVERVIEW OF THE TELEHEALTH PROJECT FOR PERSONS WITH HIV

(PWH)

Reetu Grewal, MD

Nipa Shah, MD

DISCLOSURES

This project is funded by the Centers

for Disease Control

PS17-1710

ACKNOWLEDGEMENTS

• Centers for Disease Control

• Health HIV

• Community Advisory Board

• Community Based Organizations

• JASMYN

• NF AIDS Network

• River Region

• Nassau County Health Department

• Beson 4

TELEMEDICINE AT UF JACKSONVILLE

• TM Program started in 2014

• Consent, legal, billing, technical, safety/security, educational aspects

were addressed primarily

• Staff resistance and insurer payments were main barriers.

• Neurology & Family Medicine

• September 2017 awarded CDC funds to tailor existing TM

program to PLWH

TELEMEDICINE PROJECT FOR PWH

• Goals:

• Tailor TM program for PWH, in urban setting, especially minority PWH

• Goal >200 unique PWH via TM

• Medical Care

• Ancillary Services

• Other Outcomes:

• Viral Load

• Patient/Provider attitudes towards TM

• Cost Analysis of TM

TELEMEDICINE TIMELEINE FOR PWHPROJECT

• September 2017-September 2018

• Planning Year

• Implementation Period

• September 2018-September 2020

HIV PANDEMIC IN JACKSONVILLE

Table I. HIV Incidence, Prevalence & Mortality &

Socioeconomic Characteristics for Duval County (Jacksonville

FL) residents

2015

HIV rates per 100,000 (106) population

(2013-2015)

Blacks Whites

HIV Infection rate (incidence) 73.1 13.3

HIV cases (prevalence) 47.4 7.7

HIV/AIDS age-adjusted deaths

(mortality)

15.1 2.8

Socioeconomic status (2015)

Living below poverty level (%) 28.7

±1.2

12.3

±.6

Graduated high School (%) 83.3 ±1.2 90.9

± .5

Household income ($ median) 33,145

±980

54,447

±1078

WHAT’S THE PROBLEM WITH CURRENT CARE?

Stigma being seen at HIV clinic

Access to transport

Wait/Visit Time

Lost Income Missed Work

Daily Caseload

Full Schedule

Limited time for complex

care

Utilization of Emergency

Care

Telemedicine is effective in rural areas where access to HIV

specialists is limited. Can it work in the urban setting too?

HOW TO ACCESS CARE

PROGRAM DEVELOPMENT

Capacity Building/Infrastructure

- SOPs

-Provider/Staff Training

-Organizational Infrastructure

-Equipment & Installation

-Reimbursement

-Tech Support

Promotion and Marketing

- Material review & development

- Beson4

-Dissemination & Knowledge Sharing

Community Engagement

- CAB

- Press Releases

Program Metrics and Evaluation

- Data reporting process

- EPMP

Implementation & Barriers

- UF CARES

- UF CHFM

- CBOs

CAPACITY BUILDING/INFRASTRUCTURE: UF CARES

• Services

– Pediatric care

– Chronic Disease

Treatment: HIV, Hep B/C

– Gynecology

– Social Work/Case Mgmt

– Psychology

– Pharmacy

ELIGIBILITY CRITERIA

• Clinical: Diagnosis of HIV

• MyChart: Patient has an active MyChartaccount

• Established patient:

• UF CHFM: Patient has been seen in the UF Health system within the last year and their HIPAA Acknowledgement and Consent for Treatment forms will be valid (less than one year old) at time of the Virtual Visit.

• UF CARES: Patient has been seen at UF CARES of UF CHFM (for HIV related care) within the last 6 months and their HIPAA Acknowledgement and Consent for Treatment forms will be valid (less than one year old) at time of the Virtual visit.

ELIGIBILITY CRITERIA CONTINUED

• Reimbursement: Insurance covers or grant reimburses

• Tech Capability:

• Patient either has their own, or access to, a Telemedicine capable device (smart phone,

tablet, laptop or computer w/ webcam)

ELIGIBILITY CRITERIA FOR A TM VISIT

• Symptoms that would NOT be appropriate for a Telemedicine Visit:

ANY ACUTE/LIFE-THREATENING ILLNESS

• Medical complications or conditions NOT appropriate for Telemedicine Visit: CD4 count < 200 cells/mm3

Unstable chronic disease Chronic pain – requiring narcotics be prescribed during the

Virtual Visit

EMR UPDATES

Best Practice Alert

PROMOTION & MARKETING

PROMOTION & MARKETING

PROMOTION & MARKETING

PROMOTION & MARKETING

• https://www.youtube.com/watch?v=paoPNecv1b0&feature=you

tu.be

• Patient Education Video

• https://www.youtube.com/watch?v=pVn4a61Ilsg&feature=youtu.

be

https://www.youtube.com/watch?v=paoPNecv1b0&feature=youtu.behttps://www.youtube.com/watch?v=pVn4a61Ilsg&feature=youtu.be

COMMUNITY ENGAGEMENT: CAB

• ~15 members consisting of PLWH patients, community-based organizations (CBOs), academic and medical experts

• Meets Quarterly to review all aspects of project

• Promotion and marketing campaign

• Guidance on program development and implementation

• Focus Group Guidance

PRE-COVID-19 DATA

• As of 8/26/19:

• 71 TM visits conducted

• 58 unique patients

• As of 2/10/20:

• 178 TM visits conducted

• 115 unique patients

• Ancillary Services:

• Psychology (3 visits, 2 unique patients)

• CBO Partners

• Nassau County only

CHANGES POST COVID-19

• UF CARES Clinic is located within/adjacent to UF Health Jacksonville Hospital

• UF Health Jacksonville consolidated entrances for patients and staff

• Eligibility Criteria loosened

• All patients eligible regardless of CD4 count

• All patients are converted to TM visit or rescheduled for later

• New patients can be seen via TM

• Emergency care only in clinic

CHANGES POST COVID-19

• Increase in utilization of TM from community partners

• Most CBOs closed during early pandemic

• PWH used their own technology

• Reimbursement for TM from most insurance plans

• Connection issues mostly resolved with Zoom platform

IMPLEMENTATION UPDATE

• As of 8/10/20:

• TM visits conducted 595

• Unique patients 360

• Ancillary Services:

• Psychology (142 visits, 84 unique patients)

• Pharmacy (28 visits, 18 unique)

• Nutrition (67 visits, 66 unique)

• Case Management (28 visits, 24 unique)

OTHER DATA POINTS

• Focus Group Analysis

• Patients, Providers, Ancillary Staff

• Finalized 2 year data

• Who Utilized TM?

• VL over time

• Stability, Improvements?

• Cost Analysis

• Cost Savings with TM?

THANK YOU!!

Reetu.Grewal@jax.ufl.edu

Nipa.shah@jax.ufl.edu

mailto:Reetu.Grewal@jax.ufl.edumailto:Nipa.shah@jax.ufl.edu