An Overview of The Alfred’s priorities for service change

An overview of The Alfred’s priorities for service change (MS Word File 28KB)

The Alfred worked closely with the consultants within the first phase of the review to identify recommendations.  From this we prioritised what we saw as the key areas for service development.  Below we have provided a very brief overview of some of the key areas or proposed changes to provide some of the thinking behind the suggestions. 

Commencement of PEP Service

The Alfred has provided a Post Exposure Prophylaxis (PEP) service for people who have had community exposures to HIV since 2000.  PEP is one element in HIV prevention and is thought to reduce the risk of HIV transmission where there has been an exposure.  Victoria, however, has not had funded access to PEP for community exposures across the state.  In August 2005 The Alfred launched a statewide PEP service which will support other services across Victoria to provide PEP.  This will over time include provision at other hospitals.  PEP is also now available at high HIV caseload GP clinics through S100 trained prescriber GPs.  The Alfred coordinates this service and funds the PEP medications (as they are not on PBS) that these health services prescribe.  The Alfred also established a 24hour telephone information line to provide information and triage individuals where required.   

Change in patterns of inpatient care

With advances in HIV treatments the number of people with HIV admitted to hospital and the time they stay in hospital has decreased. Specifically, people who are unwell to the level that they need to stay in hospital where there is a high level of access to medical and nursing intervention (which we call an acute admission) has changed.  This change is consistent across many hospital services in Australia and the developed world.  This has resulted in a drop in the number of people needing to be admitted into an acute bed; however we have seen a rise in people accessing the sub acute beds in Fairfield House. 

Though the need for acute admission has reduced there are many other areas where hospital and specialist HIV services need to grow and develop to meet the changing needs for people living with HIV/AIDS.  The Alfred is proposing to move resources that are currently linked to the acute beds on 7 West that are not being used by patients who have HIV into other areas of health care where new resources are needed for people living with HIV/AIDS.  An example of this is creating more HIV ambulatory and psychiatric services. 

This change will reflect what has been occurring on Ward 7 West for the past several years.  We do not expect that the numbers of people requiring acute admissions will increase to the levels they were in the early 90’s.  If this did happen, people who were acutely unwell would still be treated and The Alfred would utilise existing beds within the hospital.  

Does this mean it will be harder to get an acute bed?  The simple answer is that this change should not affect access to acute hospital beds.  Patients will continue to have the same access that they currently have. 

We propose to officially have 15 beds on 7 West that are linked to HIV funding.  The past 5 years of acute bed usage by HIV positive patients suggests that this is a reasonable number of beds.  When there are people living with HIV/AIDS who are acutely unwell filling those beds, access to a hospital bed will still not be compromised in any way. We will continue to have our commitment to rapid assessment and transfer through the emergency department for all our patients.

What about Fairfield House?  These changes will not impact on access to sub acute beds within Fairfield House.  Fairfield House will continue to have 15 beds utilised by people living with HIV/AIDS. 

Mental health services

For some years there has been a need to increase and expand the mental health services the Statewide HIV/AIDS Service provides to work with people with HIV.  A large number of people living with HIV/AIDS have some level of mental health illnesses or need to access mental health services during the course of their illness.  This may result from a mental health illness that was pre-existing, an outcome of having HIV, side effects of HIV treatments or due to neurocognitive changes from HIV.   An example of this is that 40% of people referred to Fairfield House had psychiatric management, review or assessment as their secondary indication for admission. 

There is a need to increase staffing resources to address the psychiatric and neuropsychiatric illnesses people are presenting with.  These services would not solely target people attending The Alfred.  The resources would be aimed at increasing the access to psychiatric assessment, by improved support to HIV specialist GPs in the community and other acute hospital HIV services.  This would also include providing greater access to psychology and neuropsychology services. 

Ambulatory care

Ambulatory care refers to a range of health services that are provided on an outpatient basis, in contrast to services provided in the home or to people who are inpatients.  The term ambulatory care usually implies that the patient must travel to a location to receive services which do not require an overnight stay.

It is this type of care where the need for services for people living with HIV/AIDS is increasing.  There are a greater number of people living with HIV within Victoria each year as fewer people die.  The complexity of people’s care is also increasing as people have pre-existing or emerging health issues emerging such as mental health, drug and alcohol and hepatitis C.  There are also a number of side effects of treatments which need to be addressed in an ambulatory setting such as the management and prevention of heart disease and lipodystrophy. 

The Victorian HIV Service is seeking to respond to these issues by improving the coordination of care for people where multiple specialists are involved.  An increase in the nursing and specialist medical services within the ambulatory setting will address these needs. 

Outreach services

The aim of the proposed outreach services are to improve support and access to a range of specialist health services outside of The Alfred.  These will be based at existing health services.  They will either provide direct care to people at those services or support other services in their provision of specialist HIV services.  For example we would aim to increase our provision of specialist HIV nursing resources to work within the Monash Medical Centre’s HIV Outpatient Clinic.  We also currently provide HIV specialist medical services to Healthworks which is a primary health service in Footscray. 

The basis of this is to ensure the Statewide HIV Service responds to new groups who have HIV, for example at Healthworks the service sees a number of people who are HIV positive who have a history of injecting drug use and are from Vietnamese backgrounds.  The work within Port Phillip Prison is along a similar line.  There are groups of people living with HIV who need access to services in different ways than within a traditional hospital setting which we are attempting to address through this proposal. 

We also plan to offer outreach services to acute hospitals which see a significant number of HIV patients.  Some of these services do not have specific resources to work with people living with HIV and are seeking resources to meet the demand in their services.  We do not expect everyone to come to The Alfred for treatment and care and as a statewide service we propose that it be a part of the service’s role to provide a level of support and service provision in an outreach model to other hospitals.  The model for this would need to be negotiated directly with each service so that it meets their needs.  The aim would be to support and add value the work of the existing service and attempt to ensure equity of access to the range of health services that The Alfred provide. 

Commitment to ongoing service developments

There are a number of other recommendations which The Alfred also believe are important in continuing to meet the emerging needs of new communities being infected with HIV such as the HIV culturally and linguistically diverse (CALD) service.  Sexually transmissible infections (STIs) are also important to target within the Victorian HIV Service as it is suggested that STIs increase the risk of HIV transmission so this is another key element in reducing HIV infection in the community. 

New technologies continue to develop in the HIV area, some of these technologies assist the service in better identifying treatment options or the impact that treatments are having on individuals which ultimately lead to better health outcomes. 

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