Integrated Practice Unit’s (IPU)

• Organized around the need’s of patient’s• Provides the full cycle of care for a condition,

including patient education, engagement and follow-up

• Involves a dedicated team who devote a significant portion of their time to the medical condition

• Providers are part of a common organizational unit

• Co-located in dedicated facilities Source: Michael Porter 2010

Community Health and Well being Integrated Practice, Care For HIV Patients

Veronica Ford

COVENTRY’S INTEGRATED SERVICE

• An integrated Sexual Health and HIV service, including Family Planning and GUM

• Trust clinical strategy to develop Integrated Practice Units

Prevalence of HIV in Coventry • General population in Coventry of

323,132• Over 600 HIV patients accessing Integrated

Sexual Health Service • Prevalence of HIV is 3% per 1,000 people

aged 15-59

Background• HIV is a complex disease and is considered

to be a treatable Long-Term Condition• Antiretroviral Therapy has improved

survival dramatically• Co-morbidities including mental heath

issues have been identified as important co-morbidities • Management of HIV patients need multidisciplinary team

approach• Lifestyle advice and Mental Health Support

can improve survival with improved quality of life (BHIVA Guideline)

IPU - Work to Date

• Development of Screening Tool• Complies with BHIVA Standards of Care for

People Living with HIV• Leading to Single Assessment• Integrated working/joint clinics • Effective use of existing resources• Increased range of services to clients

Previous Pathway

HIV Consultation

Dietician

THT

iAPTPsychosexual Counselling

Current progress

HIV consultation

Lifestyles service

THT service

Dietician

iAPT service

Physiotherapy

Specialist Psychiatric

and Psychological

services

Alcohol support

Smoking support

Weight support

Lifestyle Health Checks

Individuals aged 18 and above to identify risks and make healthy lifestyle changes.

Initial 45 minute assessment includes:

BMI measurement

BP, Glucose & Cholesterol testing

Smoking status, diet, physical activity, alcohol consumption

GAD/PHQ for Mood & Anxiety.

Lifestyle Health Checks

Following initial assessment, the client can attend a structured six week programme to improve lifestyle and reduce risk:Eat & Drink Healthy, Be active, Reduce Smoking & Alcohol, Feel good and sleep wellMove onto Case Management or Stop Smoking Programme

•Delivering parallel healthy lifestyle and IAPT clinics within the service • Team encouraging HIV patients to attend Lifestyle check•Closer liaison and working between MDT • Onward support offered with a range of external agencies

IPU in Practice

Results so Far• IAPT has already identified patients who need

help including Cognitive Behavioural Therapy– Management plans agreed with consultant

through MDT discussions– Positive feedback from patients and clinicians

• IPU assists with the early intervention to reduce the complex co morbidities and also help with the identification of comorbidities such as hyperlipidaemia.

iAPT

15%

42%

43%

% patients offered IAPTService

% patients signposted toanother service

% patients who either did notneed or want futher support

Life Style Support

15%

17%

17%25%

2%

24%patients to stop smokingsupport

patients on counterweight

patients on to IAPT

patients referred toPhysiotherapy

patients on to AlcoholSupport Services

patients on to additionalcase management support

Case study 1• Male, aged 56 years diagnosed positive for 5

years on ART for 4years• Completed lifestyle health check and was

motivated to make lifestyle behaviour changes. • Completed support with ‘Eat Well’ sessions with

Lifestyle advisor. • He achieved his goals relating to the frequency of eating, portion

size and types of food groups eaten. His starting weight was 103kg and is now 99kg.

• Quote – ‘Quite surprising the things you take for granted that are wrong in your life, you think you are doing good but you can do better, fine tuning needs to be done.’

Case Study 2• Female, aged 53 years diagnosed 6 years ago• Supported with behaviour change to ‘sleep well’. • Her sleep improved and she is also now accessing physiotherapy

after being referred following check for her leg problem. • Following the sleep improvement she is now accessing • Counterweight, a weight management programme, with our lifestyle

advisor and is following a personal health plan. • She has lost 4.6 kg already and is still on the programme. (Starting

weight 75.6kg, now 71kg) • Quote ‘Feel more self-aware and in control of my eating and

sleeping; realising that you have habits and somebody is helping you to stop and think. ‘No thank you’ is now my mantra for the week.’

Healthy Lifestyles Sexual Health Feedback Data Analysis Q6 Do you feel the staff listened to you?Q7 Is the place where you go for your appointment convenient for you to get to?Q8 Do you think the support offered by the Health professional has helped you adopt a healthier lifestyle?Q10 What is your overall view of the service?Q11 Focus group

NB N/A = Not answered

Healthy Lifestyles Sexual Health Data Analysis

Q2 Q3 Q4 Q5

How would you rate the appointment times offered to you?

How would you rate the greeting you received from reception staff/Health professional on arrival?

How would you rate the approach ability and professionalism of the health professional?

How would you rate the explanation of the programme and the information given to you?

Q9

What is your overall view of the service?

Excellent, 4

Excellent, 7

Excellent, 6 Excellent, 6

Excellent, 5

Good , 7

Good , 4

Good , 5 Good , 5 Good , 5

N/A, 2

0

1

2

3

4

5

6

7

8

Q2 Q3 Q4 Q5 Q9

Excellent

Good

N/A

NB N/A = Not answered

BHIVA STANDARDSStandard 3

• Provision of outpatients treatment and care for complex co-morbidity- the IPU may assist with the early intervention to reduce the complex co morbidities and also help with the identification of comorbidities such as hyperlipidaemia.

• Access to emotional support  and smoking services

• •

Standard 6 • Psychological care – promotes emotional and

cognitive wellbeing that will impact on the quality of care and wellbeing for people attending the service

Standard 9 • Promote self-management – smoking cessation

to support wellbeing- encouraging a self-management  weight plan  

Standard 10• Participation of people with HIV in their

care – empowering patients to be involved in the their care pathways .

• The IPU helps patients to participate in identifying need and identify and select  other areas of care that may help them to live well.

 

• By implementing an IPU we are working to ensure HIV patients have the best programme of health care

• Supporting/encouraging self management to • Wrapping services around the patients, and

ensuring the clients do not need to be referred onto other services

• Reduction in client waiting time to access other health services

Benefits of IPU

• Reducing admin time to book new appointments• Reduces DNA rates • Reducing time and money spend by healthy

lifestyle services promoting services e.g. promotional material

• Shared equipment and administration support

Benefits of IPU

Future Plans

• Single set of medical records• Expanding screening tool• Inclusion of additional services • Formalising outcome framework • Training for Sexual Health Staff to

undertake the screening

QUESTIONS