1. Effective Consultation via Case-Conferencing John Roberts, MSN, RNCS Donna Gallagher, MS, RNC, ANP, FAAN 2003 National AETC Faculty Development Workshop August 14-16, 2003

2. Session Objectives Discuss group clinical consultation Describe one strategy for successful implementation of a group consultation series Review the perils and pitfalls of this approach Highlight the successes

3. Level IV Clinical Consultation Purpose Change in Clinical Problem Solving Change in clinical decisions for better or more appropriate care Impart state-of-the-art knowledge around specific HIV patient care

4. Level IV Clinical Consultation Method Interaction between clinical consultant & clinical consultee(s) Patient specific question via appropriate medium Provider (learner) driven

5. NEAETC Clinical Consultation Series Rapid, ongoing changes in HIV care Difficult for dedicated providers to keep up Tertiary centers have different options for education Community practices have limited options

6. NEAETC Clinical Consultation Series Bring the consultant and information to the consultees Diverse groups of community providers Stable attendance Peer support

7. Overview of Current Programs Dimock CHC Lynn CHC OASIS Consortium Lowell CHC Lawrence CHC Worcester VNA Great Brook Valley CHC Worcester Family CHC Health Care for the Homeless Umass ID Rounds BIDMC HIV Rounds Brightwood CHC Brockton CHC Jordan Hospital Cape Cod Hospital Outer Cape CHC Haverhill TCA

8. Finding Sites Title III grantees Community provider networks Industry generated leads Consumer feedback State DPH feedback

9. Developing sites Outreach to individual providers Schmooze factor Meet with HIV team/providers Needs assessment Formal & informal Develop list of topics Understand audience for site

10. Speakers Sources of speakers AETC PIs and staff AETC developed faculty Industry leads Local experts Added advantage of expanding access to local resources Relationship building National experts Pharmaceutical partnership Difficult to direct content

11. Speakers Guiding speakers to incorporate cases Make the Case the Up Front Goal Give Speakers Sufficient lead time to refine cases Provide case and format examples Team with a Clinician coordinator

12. Case Incorporation Speakers Develop case to open and interweave with content Encourage audience to bring cases to present Key contact(s) for each site NEAETC clinical faculty person present to interject cases

13. Pitfalls Speakers who dont pause Pharmaceutical developed (canned) curriculum Inflexible or inexperienced speakers Faculty that is unable to respond to audience direction

14. Successful Topic suggestions Diverse spectrum of HIV disease Post conference updates HAART Resistance System focused Gender focused Women, Gay men, Transgender

15. Successful Topic suggestions HIV, Mental Health & Substance Abuse HIV Neurology Pulmonary Complications of HIV Gynecologic Complications of HIV Hematologic Complications of HIV HIV Dermatology

16. Program QI Speaker contact by clinical faculty Able to discuss content Clinical review Clinician at program Administrative review Program evaluations

17. Making it work Stable location Consistent time Regular advance notice Email & flyer Pharmaceutical support Food, honoraria, costs CE credit Streamline paperwork PIF checkoffs

18. How are we doing Who attends by site Aggregate data

19. What do we hope to Offer Providers? Education Peer support Access to a consultation network to enhance state of the art care

20. The future? More sites, expanding geography Expand topics Blend audience MAI initiative – case mgrs, etc. Creativity with shrinking $$ Distance learning