Management of Hiv/Aids on the Mid North Coast: A Collaborative Model of Care Involving General Practitioners and the Public Health System

Abstract

The Coffs Harbour AIDS Information Network was set up to co-ordinate care planning and support service delivery for HIV/AIDS patients. This paper describes a collaborative model of care that brought together private general practitioners, a community nurse and a sexual health counsellor. Time involved in delivering services was monitored for each of the health professional groups during a 6 month period. Twenty-three patients were involved in our study. Doctors averaged 23 min per consultation over 57 occasions of service. Travel or telephone contact took up 17% of the time spent on these patients. Corresponding figures for the nurse and counsellor were an average of 67 min over 144 services and 71 min over 16 services. They spent 16% and 27% of their time travelling or on the phone, respectively. HIV/AIDS care is time consuming for health professionals but comprehensive care can be given in rural areas with adequate support and integration.

A scoping literature review of collaboration between primary care and public health

“…Collaborations between PC and PH served a variety of client populations, and, as Figure 1 shows, involved a full range of activities. Community activities included community engagement and participation (Bennett et al ., 1994; Alexy and Elnitsky, 1996; Billingham and Perkins, 1997; Lundeen et al ., 1997; McDonald et al ., 1997; Ewles, 1999; Harper et al ., 2000; Margolis et al ., 2001; Oros et al ., 2001; Heller et al ., 2003; Carlisle et al ., 2004; Andrews, 2002; Fraser, 2005; Michener et al ., 2005; Rothman et al ., 2005; Asaid and Riley, 2007), community development (Billingham and Perkins, 1997; Heller and Goldwater, 2004; Brown et al ., 2007) and multi-sectoral involvement (Billingham and Perkins, 1997; Arora et al ., 2000; Wilson et al ., 2000). Various types of jointly offered health promotion (Fatchett, 1990; Wiles and Robison, 1994; Wood et al ., 1994; Lasker and The Committee on Medicine and Public Health, 1997; Cook, 2000; Bindman et al ., 2001; Oros et al ., 2001; Heller et al ., 2003; Riley et al ., 2003; Dion, 2004; Kearney et al ., 2005; Rothman et al ., 2005; Brown, 2006; Sanders et al ., 2008), health education (Lambrew et al ., 1993; Bennett et al ., 1994; Alexy and Elnitsky, 1996; Harper et al ., 2000; Record et al ., 2000; Thackway et al ., 2000; Bourdages et al ., 2003; Harris et al ., 2003; Heller and Goldwater, 2004; Ferrari and Rideout, 2005; Kearney et al ., 2005; Mack et al ., 2007; McElmurry et al ., 2009; Sanders et al ., 2008) and illness/injury prevention initiatives (Lasker and The Committee on Medicine and Public Health, 1997; Lundeen et al ., 1997; Crump et al ., 1999; Rogers et al ., 1999; Lemelin et al ., 2001; O'Neil and Clarkson, 2002; Heller et al ., 2003; Heller and Goldwater, 2004; Meyrick,…”

“…Various types of jointly offered health promotion (Fatchett, 1990; Wiles and Robison, 1994; Wood et al ., 1994; Lasker and The Committee on Medicine and Public Health, 1997; Cook, 2000; Bindman et al ., 2001; Oros et al ., 2001; Heller et al ., 2003; Riley et al ., 2003; Dion, 2004; Kearney et al ., 2005; Rothman et al ., 2005; Brown, 2006; Sanders et al ., 2008), health education (Lambrew et al ., 1993; Bennett et al ., 1994; Alexy and Elnitsky, 1996; Harper et al ., 2000; Record et al ., 2000; Thackway et al ., 2000; Bourdages et al ., 2003; Harris et al ., 2003; Heller and Goldwater, 2004; Ferrari and Rideout, 2005; Kearney et al ., 2005; Mack et al ., 2007; McElmurry et al ., 2009; Sanders et al ., 2008) and illness/injury prevention initiatives (Lasker and The Committee on Medicine and Public Health, 1997; Lundeen et al ., 1997; Crump et al ., 1999; Rogers et al ., 1999; Lemelin et al ., 2001; O'Neil and Clarkson, 2002; Heller et al ., 2003; Heller and Goldwater, 2004; Meyrick, 2004; Chambers et al ., 2005; Kearney et al ., 2005; Brown, 2006; Harrison et al ., 2006; PHRED, 2006; Stevenson Rowan et al ., 2007) were reported. The most commonly offered health services were general PC services (Alexy and Elnitsky, 1996; Lundeen et al ., 1997; Poulton, 2000; Record et al ., 2000; Andrews, 2002; Heller and Goldwater, 2004; Ferrari and Rideout, 2005; Brown, 2006; Kaufman et al ., 2006; Shirin and Absher, 2006; de Guzman, 2007; Jackson and Marley, 2007; Taylor et al ., 2007), chronic disease management including screening (Alexy and Elnitsky, 1996; Rogers et al ., 1999; Record et al ., 2000; CIHR, 2003; Chambers et al ., 2005; Ferrari and Rideout, …”

“…Developing community-based committees with diverse membership mandated with an advisory or steering function was a key leadership approach to facilitate collaboration. Community engagement and representation on these committees were essential for collaborations to be responsive to community needs and facilitate joint planning (Machala and Miner, 1994; Alexy and Elnitsky, 1996; Billingham and Perkins, 1997; Crump et al ., 1999; Ewles, 1999; Harper et al ., 2000; Wilson et al ., 2000; Bindman et al ., 2001; Oros et al ., 2001; Andrews, 2002; Michener et al ., 2005; Rothman et al ., 2005; Kaufman et al ., 2006; Asaid and Riley, 2007; Sanders et al ., 2008). Involvement of multiple professionals was also important to develop buy-in (Lambrew et al ., 1993; Alexy and Elnitsky, 1996; Margolis et al ., 2001; Iliffe et al ., 2002; Shandro, 2003; Ciliska et al ., 2005).…”

“…At the practice level, there were improvements in the understanding of PC and PH concepts, areas of responsibility and roles Headland et al, 2000;Leeds et al, 2000;Cook et al, 2001;Heller et al, 2003;Morgan and Kelly, 2004), team functioning (Gerrish, 1999;Leeds et al, 2000;Andrews, 2002;Riley et al, 2003) and information sharing Banks-Smith et al, 2001;Kaufman et al, 2006).…”

“…O' Neil and Clarkson (2002) Andrews (2002) Harrison et al (2006) Olney and Yoon (2007) Arora et al (2000) Harrison and Keen (2002) Oros et al (2001) Asaid and Riley (2007) Headland et al (2000) Pierce et al (2007) Ayres et al (1996) Heller and Goldwater (2004 Mayo et al (1996) Gerrish (1999 McDonald et al Meyrick (2004) Harris et al (2007 Morgan and Kelly (2004 …”