SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements:
Volume 3, Issue 14 (July 10, 1998)

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.

University of Washington Project Addresses Complications of Delirium through Provider Training

Investigators at The University of Washington have developed a model training program on the neuropsychiatric disorder delirium, which affects many HIV/AIDS patients. Delirium is characterized by disturbances in consciousness, an inability to control attention, and memory disturbances. Delirium has a rapid onset and is caused by several physical factors such as medical problems or medication use.

Having documented the degree of the lack of knowledge and attention given to delirium by health care providers¹, the project has focused subsequent efforts on education and training. Training has included didactic presentations or case discussions at participating hospitals and clinics and psychiatric screening. In addition to training directed toward hospital and clinic health care providers, the program provides educational counseling to the families and clients. The program also has developed an instructional videotape, Unmasking AIDS-Related Delirium, which provides information about diagnosing, managing, and preventing delirium. The tape includes a study guide that provides complementary information for training facilitators using the videotape to help both HIV/AIDS care providers and the families and friends of HIV/AIDS patients understand AIDS-related delirium.

Identifying the cause of delirium is important in managing it. Causes may be simple, such as dehydration, sleep deprivation, or anemia, as well as infections and high fevers. Medication may cause delirium, as well. Thus, behavioral interventions can be used to manage various aspects of delirium which medications cannot fully address. Preventing delirium may be achieved through the following: careful review of the patient’s medications; non-pharmacotherapy options, such as helping the patient to relax and wind down at bedtime to maximize sleep; reducing risk of trauma by increasing the patient’s physical strength, balance, and coordination; and minimizing changes in the patient's environment.

What are some of the consequences of not identifying and preventing AIDS-related delirium? University of Washington investigators studied 110 hospitalized patients over a one-year period for evidence of delirium. For those patients identified with delirium (12 percent), the overall level of medical problems was no different from that of patients without delirium. However, five patients with delirium (63 percent) died during hospitalization compared to none of the non-delirious patients. In addition, patients with delirium were more likely to need skilled nursing home care following the hospitalization than patients without delirium (50 percent). Finally, the length of inpatient stay for patients with an episode of delirium was significantly longer than for patients without delirium (average of 11 days for those with delirium as compared to an average of 5 days for patients without delirium). Thus the importance of training and education for permitting the early identification and management of patients with delirium is critical to improving a range of health outcomes. If detected early and treated appropriately, HIV/AIDS patients with delirium may stand a much better chance of living longer, healthier lives.

For further information contact Karina K. Uldall, M.D., M.P.H., University of Washington, Center for Health Education and Research, 901 Boren Avenue, Suite 1100, Seattle, WA, 98104, 206/221-4944, 206/221-4945 (fax), keegan@u.washington.edu (e-mail). Information about the videotape, Unmasking AIDS-Related Delirium, is available from Dr. Uldall, as well as on the Internet at www.TheMeasurementGroup.com/resource/unmskdel.pdf.

1Lalonde, B., Uldall, K.K., & Berghuis, J.P. (1996). The trouble with delirium in AIDS patients: The discrepancy between occurrence and health care provider identification. AIDS Patient Care, 10(5), 282-287.

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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