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Email service for patients saves time, money and clinic visits

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.

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In general, patients at their clinic fit this profile:

  • 88% are taking ART
  • 95% of ART users have a viral load less than 50 copies/ml
  • 68% get home delivery of their medicines

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:

  • have been under the care of a clinic physician for more than one year
  • have stable viral load test results (at least two consecutive test results less than 40 copies/ml) or more than 350 CD4+ cells
  • have no other health conditions
  • have Internet access
  • have a family physician

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:

  • 91% men, 9% women
  • 88% were white
  • 83% were men who have sex with men (MSM)
  • participants ranged in age from 21 to 81 years with the mid-point being 47 years
  • all had stable HIV infection with 93% on ART and 97% of ART users had a viral load less than 40 copies/ml
  • diagnosed with HIV for 11 years

However, eventually 33 participants chose to leave the email service for these reasons:

  • preferred to be seen every six months – 10 patients
  • missed more frequent visits to the doctor – 7 patients
  • moved out of the area – 2 patients
  • problems with home delivery of medicines – 2 patients
  • computer problems – 2 patients
  • other, unspecified reasons – 10 patients

Temporary stops

At present, 117 patients have temporarily stopped using the new system because of the need for more intensive medical care, such as the following:

  • medical issues (including HCV co-infection) – 60 patients
  • entered research studies – 26 patients
  • decided to initiate or change ART – 26 patients
  • other reasons – 5 patients

Satisfaction

Overall, 90% of participants rated the service “good” or “excellent.”

Participants particularly like the following aspects of the service:

  • fewer hospital clinic visits
  • access to blood test results via email
  • the ability to go to the lab early (7:30 am) and how it does not interfere with their job

96% of participants would recommend the service to a friend who was HIV positive.

Patients left comments such as these:

  • “for busy people the service is excellent”
  • “fabulous service, roll it out for the whole country”
  • “…modern patient-centred approach to chronic disease management that other services should be copying”

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.

—Sean R. Hosein

REFERENCE:

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.