Addressing the long term psychosocial and medico-legal needs of HIV positive patients: The West Sussex structured interview (WeSSI)

Richard Williams

Dr Andrew Nayagam

Maureen Wotherspoon

Background

• Emotional support and induction

• Time constraints

• Patients’ recall

• Changing needs

• Chronic disease - changing advice

Background

• Up-to-date information

• Accountability for patient knowledge

• Responsibility to review and address patient need

• Long term HIV positive patients as well as those more recently diagnosed

Rationale

A framework is required to set standards in

the management of HIV positive patients by

addressing relevant medical, legal and psycho-

social issues

The West Sussex Structured Interview (WeSSI)

• Produced by multi-disciplinary team • Addressed a range of psychosocial and

medico-legal issues

• Focussed on patients diagnosed for more than 3 years

• Patient satisfaction questionnaire

Audit results: Demographics (N=20)

• 10 male, 10 female

• 11 White European, 9 Black African

• 13 heterosexual, 7 homosexual • 2 age 16-24, 8 age 25-39, 10 age 40+

• 2 diagnosed < 6/12, 1 diagnosed 6-12/12, 15 diagnosed > 3 years

Results (N=20)

• 19/20 required either an intervention or received new information

• 14/15 patients diagnosed >3 years received either an intervention or new information

Results: Interventions (N=20)

70%

30%

Intervention (N=14) No Intervention (N=6)

Results: Interventions (N=14)

• Referral to Clinical Nurse Specialist (N=7)

• Referral to Doctor (N=3)

• Referral to Nurse Psychotherapist (N=3)

• Referral to Women’s Group (N=5)

• Provider Notification (N=2)

• Rearrangement of appointments due to concerns about confidentiality (N=1)

Results: New Information Received (N=20)

90%

10%

New Information Received (N=18) No New Information Received (N=2)

Results: New information received

• Post exposure prophylaxis for a sexual exposure (N=14)

• Prevention of mother to child transmission (N=11)

• Safe sex (N=4)

• Criminalisation of transmission (N=3)

Results: Interventions for Patients Diagnosed >3 years (N=15)

60%

40%

Intervention (N=9) No Intervention (N=6)

Results: Interventions for patients diagnosed >3 years (N=15)

• Referral to CNS (N=4)

• Referral to Doctor (N=3)

• Referral to Nurse Psychotherapist (N=1)

• Referral to Women’s Group (N=4)

• Rearrangement of appointments due to concerns about confidentiality (N=1)

Results: New Information Received for Patients Diagnosed >3 years (N=15)

87%

13%

New Information Received (N=13) No New Information Received (N=2)

Results: New information received for patients diagnosed >3 years

(N=15)• Post exposure prophylaxis (N=12)

• Prevention of mother to child transmission (N=7)

• Safe Sex (N=3)

• Criminalisation (N=2)

Results: An insight into our patients

• 8/9 Black African patients had not disclosed their result to friends

• 3/9 Black African patients had not disclosed

their results to friends, family or partners; 2 were referred to a women’s group

• 7/20 patients indicated they did not receive social support; 5 received an intervention

Results: Patient satisfaction questionnaire (N=16)

• 15/16 patients found the WeSSI ‘completely’ or ‘mostly’ acceptable

• All 16 patients who responded found the WeSSI comprehensive and relevant

Conclusion

• The WeSSI addressed unmet knowledge gaps by providing new information for 18/20 patients

• As a result of the WeSSI, 14/20 patients received an intervention

• 14/15 patients who had received their diagnosis >3 years prior to the WeSSI received either an intervention or new information

• Patients found the WeSSI relevant, comprehensive and acceptable

Recommendations

• Health advising services should consider adopting the WeSSI

• A modified WeSSI should be considered for follow up on an annual basis

Richard Williams

Lead Health Adviser Warren Browne UnitSouthlands HospitalShoreham-by-SeaWest SussexBN43 6TQ

01273 446041

richard.williams@wsht.nhs.uk