SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements:
Volume 1, Issue 9 (August 10, 1996)

Information dissemination from 27 Innovative Models of HIV Care projects funded as Special Projects of National Significance by the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA).

Introduction

Welcome to SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements. In each issue of SPNS/Fax, we will highlight findings from the HRSA Special Projects of National Significance Program Cooperative Agreements. The projects have been funded to develop innovative models of HIV/AIDS care. SPNS/Fax reports are distributed every two weeks by fax machine to all subscribers. All issues of SPNS/Fax are also available at this Web site. Due to slight differences in the media, issues distributed by fax machine may appear slightly different from those posted on this Web site, but the content is identical.

The University of Vermont Project

HIV/AIDS related needs unique to rural patients and health care providers in Vermont are being addressed by an innovative model instituted by the University of Vermont. The project supports the implementation and development of three clinics across the state in the communities of Rutland, Brattleboro, and St. Johnsbury through collaboration with the Comprehensive Care Clinic in Burlington. Previously, the only source of health care for people with HIV/AIDS was the Comprehensive Care Clinic. A single referral clinic required HIV/AIDS patients in rural Vermont to leave their communities or travel substantial distances. Prior to the opening of the Rutland clinic, about 90 percent of the patients traveled more than one hour, and some traveled more than 3 hours. After the clinic opened, less than 10 percent of the patients traveled more than one hour. In addition to distance barriers, primary health care providers in rural areas had difficulty keeping updated with HIV/AIDS information. In a survey of regional primary health care providers, half of 43 respondents indicated that they would like to participate in "mini-residencies" to increase their skills in treating HIV/AIDS patients.

The project seeks to provide comprehensive medical care and psychosocial services to HIV/AIDS patients by providing:

• local access to state of the art care;

• access to a physician who is an HIV specialist;

• psychosocial case management;

• improved confidentiality; and

• better care as a result of collaboration with their local primary care physician.

Further, rural health-care providers are educated about HIV/AIDS through clinic staff who conduct such activities as "mini-residencies" or continuing medical education lectures. A major benefit of this project's research will be greater understanding of the health status of rural patients with HIV/AIDS, the unique barriers to care faced by rural patients, and the rates of HIV/AIDS morbidity and mortality among rural patients.

The project opened its first clinic in Rutland in August 1994. This clinic was projected to serve 15 new patients the first year. However, within the first 10 months, it served 26 patients. These patients had 99 visits to the clinic's physician, 101 visits to the nurse practitioner, 13 visits to primary health care providers, and 13 visits to specialists. Approximately 80 percent of the patients were tested for syphilis, and TB. About 60 percent received immunizations. More than 95 percent of the clients were seen by the clinic's social worker, about 40 percent received referrals for counseling, and about 60 percent received referrals to an AIDS service organization consultant. These statistics reflect the project's efforts to reach rural HIV/AIDS patients and provide them with quality comprehensive health care. Through staff meetings, in service training sessions, and surveys, the project has reached and educated rural health care and community providers. With the data collected from the surveys (as well as data from patients served at the clinic), a greater understanding of HIV/AIDS issues in rural communities will be obtained. The project's second year focused on replicating its model in Brattleboro, and the third year will focus on developing a clinic in St. Johnsbury. During the fourth year, all three clinics will be operating and evaluated simultaneously.

For more information about this project, contact Christopher Grace, MD, Infectious Disease Unit, Fletcher Allen Health Care, Brown Building, Room 338A, Burlington, Vermont 05401-1435; or email at christopher.grace@vmednet.org.

SPNS/Fax is produced by The Measurement Group–PROTOTYPES Evaluation and Dissemination Center (EDC). Editorial comments should be made to The Measurement Group at 5811A Uplander Way, Culver City, California 90230, 310.216.1051, 310.670.7735 (fax).
 

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