Patient-centered care key to clinic's success
Geriatric medicine was Dr. Bruce Williams’ least-favorite area of practice when he went through residency training in the 1980s. Lately, though, more conditions associated wth aging have been cropping up in his caseload at New Mexico’s largest primary care clinic for patients living with HIV disease.
“They’re all getting older,” he says, laughing. “It’s come back to haunt me.”
That is actually good news, says Williams, longtime medical director the University of New Mexico’s Truman Health Services clinic. Patients for whom an HIV diagnosis was once a virtual death sentence now live long enough to cope with ailments like heart disease and diabetes, thanks to drug therapies that effectively suppress their viral infection.
The busy clinic, which has an active caseload of around 1,100, recently won a prestigious Level 3 certificate of recognition from the National Committee for Quality Assurance (NCQA). It was one of the the first clinics in the state to receive the ranking – NCQA's highest – and there are just six clinics in New Mexico that have earned it. Four of those clinics belong to the UNM Health System.
The certificate cites the Truman clinic’s patient-centered coordinated care management, which provides a suite of services under one roof. In addition to primary medical care, patients receive on-site psychiatric services, behavioral health and nutritional counseling, and chiropractic, acupuncture and massage treatments for chronic pain. Dental care is provided off site in conjunction with UNM Dental Services.
“My belief is that we need to know who our patients are and what their needs are,” Williams explains. “We aim to bring the services to our patients, rather than sending them out to the services.”
Williams, who has treated HIV-positive patients for his entire professional career, says the clinic sees around 130 new patients a year, many of them young men in their late teens and twenties.
Patients’ HIV status qualifies them to be seen at the clinic, which has ample expertise for managing the infection, but it also provides a full spectrum of medical care for other conditions, he says. Because some patients engage in risky sexual behaviors, for example, they may become co-infected with other diseases such as syphillis, gonorrhea, chlamydia and hepatitis C. In addition, about 70 percent of the patients cope with behavioral or substance abuse issues.
Program Operations Director Jamie Finkelstein says that while most services are provided on site, the clinic now sends teams out into the community to provide education and to test for HIV. The focus is on reaching out to younger people, including those on the UNM campus.
“We weren’t doing HIV testing,” he says. “We started in August, and in April we’re expecting to have our first month with more than a hundred tests.”
The staff and patient load have grown since the program relocated to bigger offices at 801 Encino NE, in the Medical Arts complex – to the point where another move may be in the cards. “We’ve outgrown it,” Finkelstein says, “so I’m looking for more space.”
Thanks in part to federal funding provided under the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, the clinic is open to everyone, regardless of whether they have insurance coverage. “We are here to provide care and treatment for everyone with HIV, regardless of everything,” Finkelstein says. “There are no caveats.”
The clinic – part of the UNM Medical Group – was originally housed on the first floor of UNM Hospital when Williams joined as a staff physician in 1990. It later was relocated to space leased from New Mexico AIDS Services on Truman Street NE, which accounts for its name.
UNM’s HIV program was one of the original grantees when the federal Ryan White program was passed. Case management and behavioral health services were always part of the package, Williams says. “This became particularly important in the mid 1990s, when effective therapy became available and careful adherence to complex treatment regimens became critical for success.”
“The Ryan White program developed what is now truly considered a patient-centered medical home,” he says. “I want this to be a place where people become healthy, no matter what they need.”