ARcare Uses EHR Alerts for HIV Testing and Prevention

ARcare staff at a recent retreatARcare HRSA BPHC exit disclaimer provides primary care and other specialty services in 48 clinics across Arkansas, Kentucky, and Mississippi. ARcare is dually-funded by HRSA’s Health Center Program and Ryan White HIV/AIDS Program. They provide comprehensive HIV specialty care and primary care and have a large outreach and prevention team.

Approach

With the challenge of serving rural areas and increased concerns about stigma and privacy in small towns, ARcare does extensive outreach to reach people where they are, and they focus on identifying at risk populations and testing all patients in their primary care sites that are more plentiful than their HIV clinics.

Outreach

ARcare’s outreach teams (HRSA Ryan White-funded staff) are embedded in their communities, and every member of the team works at least two hours a month at HIV testing and educational events. ARcare challenges the staff at each health center site to find potential outreach locations. They visit a variety of locations including foodbanks, churches, youth centers, and county jails. Their mobile clinic is an RV with two exam rooms for HIV testing and prevention discussions. ARcare also use large vans for private testing at events.

ARcare staff regularly appear on local morning television programs to talk about HIV testing and Pre-exposure Prophylaxis (PrEP), and they also use social media and online videos for education. The Arkansas Health Department partners with ARcare on a large HIV testing campaign, and, as a result, ARcare has seen an increase in the number of calls asking for HIV testing and prevention.

Training

ARcare trains every staff member in every clinic on HIV prevention and how to prescribe PrEP. They also train medical residents in rural areas where there isn’t a clinic to help bridge the transportation gap. They have partnered with the University of Arkansas to examine the impact of their PrEP training, conducting pre- and post-surveys with trainees. The one-hour training covers how to ask sensitive questions about sexual history, how to prescribe PrEP, and how to ensure follow up with PrEP patients. They plan to roll out the training to other organizations, including other health centers.

Electronic Health Record (EHR)

An EHR alert helps ensure that every patient gets at least a once-in-a-lifetime test. Alerts also are set for patients who are prescribed PrEP for when a follow-up HIV test is due and includes pre-set lab orders for PrEP. The EHR also has pre-set lab orders for HIV tests and initial and follow-up PrEP laboratory tests. Educational materials on HIV and other STI prevention and PrEP pop up in the EHR when a patient’s chart is marked at risk during the sexual history intake discussion.

ARcare uses the EHR for reminders for follow-up calls and visits. The reminder calls are built into the EHR/patient portal, and patients are given either a phone call message or a text message reminding them of the visit the next day. New PrEP patients receive a follow-up call at one month to ensure they are taking the medication and to check for any problems or concerns about the medication, including accessing the medication and adherence challenges. The nurse at the clinic that provided PrEP does the call, and if there are any problems, issues, or concerns that the local clinic cannot handle, it may be turned over to ARcare’s HIV staff. Monthly, a list of patients who are overdue for PrEP follow-up visits is pulled from the EHR, and they receive reminder calls.

Date Last Reviewed:  June 2019


More Information

HRSA HIV Webpage

ARcare’s HIV Training and Resources HRSA BPHC exit disclaimer

ARcare Uniform Data System (UDS)

For more information about this promising practice, contact: Dr. Dan Moore, M.D., ARcare Program Director for HIV Special Services, Chief Medical Information Officer