The “HELP” program Introducing case management approaches to HIV services in Lithuania Professor Malcolm Whitfield Sheffield Hallam University, UK

The problem Potentially fatal disease Potentially vulnerable patient groups Potential public health risk Potentially catastrophic effects from poor adherence to treatment High cost

The complex case Physical needs Psychological needs Social needs Spiritual needs

The healthcare continuum Well Population Health Management D i s a b l i n g C o n d i t i o n s 85% population = 15% cost At Risk Acute Illness Chronic Illness Complex Care Complex Case Management Predictive Modeling Health Advice Social support Psychological support Expert patients Treatment Disease Management Empowering Education/ Support Preventing complications Health Risk Assessment Lifestyle Modification Programs Prevention Screenings 15% population = 85% cost Disease Management

Risk/Cost stratification Primary Care Intermediate Care Hospital Care Self & home care Prevention General public services GP Care Treatment Diagnosis Step down Rehab. Rapid response Respite care Ambulatory care Diagnostic services Elective Acute Walk - Self Care Primary Care Intermediate Care Hospital Care Emergency Care Self & home care Prevention Social services Family Doctor Care Treatment Diagnosis Palliative Rehab. Rapid response Respite care Ambulatory care Diagnostic services Elective Acute Social care Population Risk Stratification Cost £ Current Service Settings 1% Episodic Care 15% Disease Management 14% Case Management 10% 15% 25% 50% 70% Population Health Management

Intra-organisational networks Two areas of research literature: Social network analysis – (organisations) Team working – (individuals)

Mapping the literature NetworksTeams Individual performance in Organisational networks Individual performance in team networks Organisational performance in Inter-organisational networks Team performance in intra- organisational networks The organisation of organisational networks The organisation of team networks The organisational of inter- organisational networks The organisation of intra- organisational networks

Examples of initiatives Joint assessment protocols Referral criteria Rapid response agreements Care pathways Treatment protocols Case conferences Joint management Formal co-ordination

Formal networks in the UK Cancer networks Cardio-networks Sexual health networks Child protection networks

Key features Devolved decision making Pooling of resources Common goals Shared learning and organisational development Formal co-ordination and management

Objectives of the program To introduce the core aspects case management To promote a significant emphasis on prevention both of infection and re-infection To develop inter-disciplinary, inter- organisational and inter-agency working / collaboration To improve the quality of life of people who are infected along with their family and friends

Participants 60 participants in total allocated to teams of around five people Where possible teams were multi-disciplinary with a combination of practitioners from policy, health and social care functions All team members were expected to participate in all activities Graduation from the programme was dependant on the successful completion of a project

The development process Time was allocated in each module for work on projects Faculty members were be available during these sessions to give advice and support as requested A randomly selected number of teams were expected to present their progress at the end of each module All projects will were made available to all participants at the end of the course as a learning resource

Project Work Defining the problem Setting the project goals Finding information (literature searching) Implementation (application of tools or techniques) Evaluation Conclusion

Example project topics Developing a multi-disciplinary assessment tool for use by all members in the team Adapting a quality of life measurement tool for use in monitoring service impact Developing a patient satisfaction tool for evaluating service quality Designing a case management protocol advising practitioners on the most appropriate local resource for specific problems