Many HIV-positive people who are taking potent combination therapy for HIV (commonly called ART or HAART) and who do not have co-existing conditions are generally otherwise healthy. They may therefore need to see a doctor less frequently. Doctors at a major clinic in Brighton, UK, have found that the number of HIV-positive patients in their care has been increasing by 5% to 7% per year for the past 10 years. However, staffing has not increased in proportion to the growth in the patient population at the Brighton clinic.
In general, patients at their clinic fit this profile:
The standard of care at the Brighton and Sussex University hospital clinic is to have an HIV specialist see medically stable HIV-positive patients every four months. Two weeks prior to each of these clinic visits, patients go to a lab to have their blood drawn and analysed.
In 2008 the Brighton clinic established an email service for patients with the following profile:
Prospective patients were told about the service and had to sign a consent form to become enrolled. Under the new system, routine visits to an HIV specialist were limited to once a year.
Out of the several thousand patients at the clinic, initially 33% (674) signed up for the email service and reduced visits. The average profile of participants who enrolled was as follows:
However, eventually 33 participants chose to leave the email service for these reasons:
At present, 117 patients have temporarily stopped using the new system because of the need for more intensive medical care, such as the following:
Overall, 90% of participants rated the service "good" or "excellent."
Participants particularly like the following aspects of the service:
96% of participants would recommend the service to a friend who was HIV positive.
Patients left comments such as these:
The Brighton researchers have found a way to save money and keep patients satisfied at the same time. Other clinics serving people with HIV and other chronic health conditions may find a similar service useful.
Whetham J, Hendrikx C, Fisher M. Four years' experience of an email clinic in an outpatient HIV setting. In: Program and abstracts of the 14th European AIDS Conference, 16-19 October 2013, Brussels, Belgium. Abstract PS8/6.
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