Programming Connection

Immunodeficiency Clinic (IDC) 

St. Paul's Hospital
Vancouver, British Columbia
2013

Lessons Learned

  1. Interdisciplinary approach. The access to interdisciplinary resources, both within the clinic and at St. Paul’s Hospital, makes the IDC a convenient place for its patients to receive both primary and HIV care. Most specialist appointments can be scheduled on the same day.
  2. Low-barrier access. The mixture of drop-in and appointment-based visits has allowed the IDC to reduce barriers to access for many. A non-punitive approach to missed appointments has also reduced barriers for those who are challenged by appointment times. Patient reminders the day before an appointment have reduced no-shows by 50%.
  3. Improved communication. Communication across disciplines in the clinic has been a challenge. The establishment of daily patient rounds and the development of a monthly newsletter have increased communication and collaboration among different staff teams.
  4. Lunch ’n’ learns. To address limited staff knowledge of community resources that complement the IDC’s work, the clinic now hosts lunch ’n’ learns that bring community organizations into the IDC to present on their care and support services.
  5. Nursing services. Nursing services have made the clinic much more efficient and reduced wait times. They have allowed both doctors and nurses to work to the full scope of their professions. Increasing the availability of care options has been important in engaging a population that would typically delay care.
  6. Point-of-care testing and counselling. As of November 2012, 1288 point-of-care tests have been performed at the IDC and 26 new positive results have been confirmed. This is a 2% yield, pointing to the acceptability and effectiveness of the service. As part of this service, the IDC continues to offer in-depth pre- and post-test counselling. The nurses who perform the counselling and testing have found that this is a beneficial time to discuss general HIV education and specific risk reduction strategies with patients.
  7. Case management. Given the complex barriers some people face when trying to access care, much of the work of this team involves identifying the incentive that will keep people in care. This individualized approach has proven effective for engagement of patients with complex barriers to care.