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Case -Study - Benefit & Impact of Community HIV Nurses

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Mark Platt
Member
Posts: 290
Case -Study - Benefit & Impact of Community HIV Nurses
Posted on: June 28 2016, 12:59 pm

I thought this abstract, looking at the economic benefits of HIV would be of interest to UKCAB members, especially as across the country we are seeing cuts or proposals for cut to HIV treatment and care services.
Mark

The challenge posted by HIV is ever-changing, with an ageing HIV positive population, the long-term effects of antiretroviral therapy (ART) and rising rates of HIV and sexually transmitted infection. In 2014 there was an estimated 103,700 people living with HIV in the UK, with 613 deaths (PHE, 2015).

The role of the community based HIV clinical nurse specialist (Community HIV CNS) has a long and varied history. Initially, the role was commissioned to provide specialist management for those living with HIV/AIDS who wanted to live (and die) at home and be supported with the co-ordination of services, plus the requisite palliative care for those who wished to remain in their own homes.

As HIV evolved, the role developed in response, providing specialist advice and expertise around HIV care, side-effect management and adherence to (at the time) complicated ART. The current emphasis of the Community HIV CNS role is one of complex case management, which has been described as "the process of planning, coordinating and reviewing the care of an individual" and supporting HIV self-care and management. Whilst these roles vary across the UK, the overarching remit for most Community HIV CNS is the management of a cohort of patients to prevent avoidable hospital (re)admissions and speed up discharge from wards.

Chelsea & Westminster NHS Foundation Trust Clinical Nurse Specialist (HIV Community) Shaun Watson argues that CNS roles such as his are often viewed as a luxury. By undertaking an economic assessment, Shaun demonstrates that his role not only adds value but avoids considerable costs. By supporting adherence to ART therapy alone, Shaun estimates that with a caseload of 60 - 70 patients, his intervention avoids between 162,500 and 260,000 of ART waste. Consequently the avoidance of the onward transmission of HIV saves between 3,360,000 -4,320,000 per annum. Furthermore, by presenting three case studies, Shaun illustrates how his role avoids significant costs elsewhere in the system, such as ambulance services, A&E departments, hospital beds days, GP appointments and mental health services.

Continues: https://www.rcn.org.uk/professional-development/research-and-innovation/innovation-in-nursing/building-nursing-capability-in-economic-assessment/shaun-watson




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Ben Cromarty
Member
Posts: 451
Re: Case -Study - Benefit & Impact of Community HIV Nurses
Reply #1 on: June 28 2016, 01:50 pm

Hi, Mark...

...an interesting paper, and although I confess i haven't read it in detail yes, I'm sure i will do, since it raises important issues. I think Shaun gave an input on this at the last BHIVA Conference? I seem to recognise Case 3!

It seems to me that there are quite a few areas of overlap in what this vision of the CNS role is, and what the view of peer support groups (like NYAA) think their role is. It might be helpful to go through this in some detail and untangle where the different organisations (CNS and peer support group) can provide the best support. There are some areas that fall very clearly into the CNS role, and some that fall into the peer support role. But there are many overlaps, and many areas where one provider might take a lead role, but the other can provide valuable support.

Rather than see this as competition, a careful analysis might highlight more clearly better ways of working together more effectively as we go forward.

In my marketing job, we did a lot of 2x2 matrices. These can be quite interesting in visualising a situation. So here, we can look at the impact of each activity considered in this paper, or for any patient, and plot it on the matrix: see attached diagram.

For areas where both peer support and CNS have a high impact, this could be seen as an area of joint work; for areas where CNS impact is high, but peer support impact is low, this is then best left to CNS; and vice versa; and for those areas where neither CNS nor peer support has a big impact, this should be referred on to those who can have an impact.

I'm just thinking out loud, but as we go forward, we need to be clear where the roles and responsibilities lie, and how best we can work together. This might be an aid to thinking those issues though...
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