Gregory Felzien, MD, AAHIVS, highlights “clinic champions” who help move patient care forward while facing external constraints.
Segment Description: Gregory Felzien, MD, AAHIVS, Medical Advisor, Division of Health Protection/IDI-HIV Georgia Department of Public Health, discusses “clinic champions” who move patient care forward despite constraints.
Interview Transcript (modified slightly for readability):
Felzien: We have to keep in mind how systems and facilities are set up. If we look at HIV care, we look at prevention, we look at treatment: we have several clinics, especially in rural areas, where they're not staffed 5, 6, 7 days a week. There might be a physician that comes one day a week, the nurse practitioner or the physician's assistant might be there two days a week, they might have an expanded role nurse four days a week, and they may have case managers there five days a week and other auxiliary staff.
What really makes this important, finding the champions, is finding individuals that really are passionate about this work. They may not be fully staffed but still trying to meet the needs of the communities that they serve. When you ask why is it important to look at nurse practitioners, look at case managers, look at other staff in that facility. Again, that is the client's medical home. And they're going to connect to different people in that facility. So a lot of times they'll come in and they're seeing the provider, but they're really connected to the case manager, who's really able to help them with housing, help them find other services in that local area. So really, what's important in those facilities is finding the champions.
I know I've said that a couple of times, but without those champions to really start to think outside the box and understanding that community, then really, the clients begin to miss appointments. There's a lot more nonadherence with a lot more no shows. So it is so important to have that connection because again, I go back to the point where this really, especially in rural areas, this is their support network, that facility, and having stability and having the ability to go in and talk to those individuals.
And having those champions step forward and really willing to understand where their clients are coming from, really is a huge, huge benefit for those communities. So there was a clinic in a rural area where I practice where they were screening for hepatitis C in their co-infected clients, but they weren't treating them. There was a gastroenterologist that was coming into town one to two days a month. You can imagine that there were barriers in accessing that care. Even though this individual is coming and seeing the clients, it might be three, six months before they would get an assessment. Or they'd have to get in their car and drive, several, a few hundred miles to reach the specialist. Well, what happened was the gastroenterologist had some career changes and stopped coming.
The providers called and said, “what are we to do? We don't have the gastroenterologist, how are we going to treat the hepatitis C patients?” and we come to find out that that facility was unaware of the new medications available for hepatitis C, they were still on the mindset that they had to take shots every week, this was a six to 12 month process, how we were going to do this. It goes back to my comment on finding champions. Who stepped forward in the clinic to do this? It was the nurse practitioner, and she said, “I will take this on.” And luckily the facility supported her.
We did some training, we did some telehealth. We walked them through a couple of patients using the new direct acting antivirals. And after the second client was cured of hepatitis C, they were amazed and they said “please come back and give another presentation. We didn't realize that things had gotten so much easier and that we were able to cure these individuals in 8 weeks or 12 weeks of therapy.” And the naive populations that were really excited about this and they themselves, not only had had the nurse practitioner as a champion in their clinic, they became the community champion. And, other providers started to refer to them. They met a need, and that's what we need to do moving forward, that it isn't going to be a single institution that ends the epidemic or eradicates hepatitis C. It's really this community and this teamwork that has to come together in order to meet those goals.