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Using a team approach
Linking patients to services can support adherence

View transcript below.

Linkage to social support services and resources can help improve adherence. 

Practices that are not multidisciplinary in structure can tap into community resources and implement a team approach to bring greater social support to their patients.  

LEANDRO MENA, MD: Given the complexity of the lives of our patients and their clinical issues and social issues, we all know that settings the include comprehensive multidisciplinary teams that include case management, pharmacies, social workers, health educators are probably more successful support our patients’ adherence to medications. But we know that not all clinicians have access to that. Do you have any recommendations for those who may not necessarily work in a clinic, you know, that was part of a large system? How can they address these things, these needs? 

CYNTHIA RIVERA, MD: I think I’ve found that really harnessing the resources out in the community. So, there are a lot of pharmacists in the community that are very well versed in antiretroviral regimens, and not only from the aspect of access to care. Obviously they help navigate in insurance plans, perhaps prior authorizations, things that need to be taken care of before the patients can access the medications, but they’re also knowledgeable about the drugs. If they see that one medication is be filled but another is not, leading to an incomplete regimen, they help communicate with the provider to make sure that’s not taking place. So, it’s about knowledge and access. We as providers have a duty to really know what resources are out there four our patients within the community they reside. 

DERRICK BUTLER, MD: And in a practical note, I know that, I mean, in any jurisdiction usually has maybe a website where they can find this information online, where are the aids services that are available. Sometimes it’s a matter of doing a little bit of work to find those resources, put them in place so that they’re always available for your patients, and it’s as simple as creating a, just a handout that lists services available, housing, food, legal, etc., dental, just as places that the patients can have. Here’s, here are resources in your community that you can access.

CYNTHIA RIVERA, MD: I’ve found that my patients have also educated me on resources that I didn’t know about. So, when the trust is there, it becomes kind of a patient-centric home. I’ve learned about resources for food insecurity, like you mentioned. So, a lot of times it’s really talking to the patients and having them help us help other patients.

DERRICK BUTLER, MD: Right, and I agree. I think if you’re, if someone is practicing in a facility that doesn’t have those resources that Leandro talked about, especially the behavioral health component, which I think is important, and they do have to reach out to the community. It’s about, as a provider, you know, at least find some linkage to those communities—I mean to those resources, excuse me. So, every city, even a smaller town, has some type of behavioral health services. And I think one key componenet is making sure that the staff that you have, maybe you don’t have a direct social worker for your clients or a case manager, but if you have a receptionist and, or medical assistants, making sure that they’re on board understanding what the patient’s needs are and making sure that they know that they are a part of this team also. 

LEANDRO MENA, MD: I think you’re touching into something that’s important. This requires a cultural change where everyone in the healthcare team has ownership of the patient. And the question is what can you do to support the patient, and that happens. It’s a continuum. Everyone in the healthcare team should be involved and be part of the solution in support of the patient.