Anxious Annie and the Heartless Health Advisers Claire

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Anxious Annie and the Heartless Health Advisers Claire Mc. Cluskey & Maeve Cross Royal,

Anxious Annie and the Heartless Health Advisers Claire Mc. Cluskey & Maeve Cross Royal, Belfast GUM Belfast Health Advisers SSHA Conference 2008

Thanks for the Collaboration of: o o Suzanne Gray Senior Health Adviser Angela Dorrian

Thanks for the Collaboration of: o o Suzanne Gray Senior Health Adviser Angela Dorrian Clinical Psychologist/Supervisor GUM staff Belfast Annie Belfast Health Advisers SSHA Conference 2008

Introduction: Ideas, Process and Conclusions: o o o o Annie’s story Timeline (Assessment/History) What

Introduction: Ideas, Process and Conclusions: o o o o Annie’s story Timeline (Assessment/History) What we did What was more/less helpful Interventions: Cards, Leaflet Communication- Collaboration & Consistency What happens next? Belfast Health Advisers SSHA Conference 2008

Audit 2007/2008 o o 21 Anxious patients in 1 year 17 Male : 4

Audit 2007/2008 o o 21 Anxious patients in 1 year 17 Male : 4 Female One third attended three or more times Over half phoned at least twice Belfast Health Advisers SSHA Conference 2008

Belfast Health Advisers SSHA Conference 2008

Belfast Health Advisers SSHA Conference 2008

Assessment o o o o Annie 28, Born N Ireland 10 months ago Annie

Assessment o o o o Annie 28, Born N Ireland 10 months ago Annie Kissed a man whose mum was said to be HIV +ve Total: 5 lifetime partners Married to Phil x 3 years LOSP: 7 years ago Blood transfusion locally, 2 years ago post ectopic HIV risk assessment no other risk Belfast Health Advisers SSHA Conference 2008

Card Belfast Health Advisers SSHA Conference 2008

Card Belfast Health Advisers SSHA Conference 2008

Chapter 1: Claire o o o HIV test only Seen with husband Annie declined

Chapter 1: Claire o o o HIV test only Seen with husband Annie declined antenatal HIV “Reassurance doesn’t last” “what ifs” re negative test Belfast Health Advisers SSHA Conference 2008

Chapter 1 o o o ? confidence (ectopic) Support? Patient returned in person Urgent

Chapter 1 o o o ? confidence (ectopic) Support? Patient returned in person Urgent test-attended for result-Negative Showed result Began card Belfast Health Advisers SSHA Conference 2008

Chapter 2. Two Weeks Later: Suzanne o o o Annie phoned Had read on

Chapter 2. Two Weeks Later: Suzanne o o o Annie phoned Had read on internet about unreliability of tests Reassured re risks & accuracy of tests Referred again to GP for support Checked out main support Card completed Belfast Health Advisers SSHA Conference 2008

Chapter 3. Two Weeks Later: Suzanne o o Annie attended tearful, requesting viral load

Chapter 3. Two Weeks Later: Suzanne o o Annie attended tearful, requesting viral load test Had been surfing the net! Refused by HA & Dr Reassured re accuracy Belfast Health Advisers SSHA Conference 2008

Who else knows? o o o Annie has a psychiatric nurse in the community

Who else knows? o o o Annie has a psychiatric nurse in the community GP also aware of testing Husband “frustrated” Family aware Filled card Belfast Health Advisers SSHA Conference 2008

Chapter 4. The Trouble with Testing: Suzanne o o o o HIV result not

Chapter 4. The Trouble with Testing: Suzanne o o o o HIV result not on computerized lab results Original fax not in notes 2 nd test taken Sent urgently Result in person and copy given to patient Incident report Original paper copy from lab put in notes Completed card Belfast Health Advisers SSHA Conference 2008

Chapter 5. Two Days later: Maeve o o Annie phoned requesting a viral load

Chapter 5. Two Days later: Maeve o o Annie phoned requesting a viral load Patient has trouble believing her negative result Referred back to GP for avenues of emotional support Documented in card Belfast Health Advisers SSHA Conference 2008

Chapter 6. Three Weeks Later: Claire o o o o Patient attended requesting a

Chapter 6. Three Weeks Later: Claire o o o o Patient attended requesting a viral load test Very upset and tearful Discussed support for anxiety Told again re community services and (draft) anxiety leaflet given HA offered to contact GP to link up support Patient refused Entry in card Belfast Health Advisers SSHA Conference 2008

Chapter 7. Helpful things o o Brought case to group supervision (psychology) Discussed: o

Chapter 7. Helpful things o o Brought case to group supervision (psychology) Discussed: o o Saying “no” Consistency Health Anxiety Model (Slavoski 89) Pulling ideas together more formally in leaflet (draft to date) Belfast Health Advisers SSHA Conference 2008

Belfast Health Advisers SSHA Conference 2008

Belfast Health Advisers SSHA Conference 2008

Chapter 8. One Week later: Maeve o o o Conversation overheard by Maeve of

Chapter 8. One Week later: Maeve o o o Conversation overheard by Maeve of medical ward Dr phoned re extremely anxious woman (Annie) who thought she had HIV-wanted her seen by GUM Dr discussed with Maeve – awareness raising. Patient seen by consultant in GUM Annie requesting viral load test Dr repeated test on condition he could contact GP who made contact with Annie. Belfast Health Advisers SSHA Conference 2008

Chapter 9: A Collaborative Approach o o o GUM staff involvement (consistent approach) 3

Chapter 9: A Collaborative Approach o o o GUM staff involvement (consistent approach) 3 Health Advisers 4 Doctors Clinical psychology (Supervision) Information sharing and updating Confidentiality – Risk & Opportunity in contacting other support patient has accessed e. g. GP Belfast Health Advisers SSHA Conference 2008

Lessons Learned: Further Collaboration Opportunity o o o Husband/Couple work GP Community mental health

Lessons Learned: Further Collaboration Opportunity o o o Husband/Couple work GP Community mental health support CPN Liaison with community groups so we can refer better Consistency of approach as a GUM multidisciplinary team Belfast Health Advisers SSHA Conference 2008

Final Chapter: Positive Outcomes: o o o o Lets us work within our competence

Final Chapter: Positive Outcomes: o o o o Lets us work within our competence Give responsibility back Signpost patients to useful support Enhance team communication Feel Okay about saying “no” Cards Supervision Patient leaflet created Belfast Health Advisers SSHA Conference 2008

Happily Ever After…. ? ? . . . Belfast Health Advisers SSHA Conference 2008

Happily Ever After…. ? ? . . . Belfast Health Advisers SSHA Conference 2008