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

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

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

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

5. Belfast Health Advisers SSHA Conference 2008

6. Assessment  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

7. Belfast Health Advisers SSHA Conference 2008 Card

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

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

10. Belfast Health Advisers SSHA Conference 2008 Chapter 2. Two Weeks Later: Suzanne  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

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

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

13. Belfast Health Advisers SSHA Conference 2008 Chapter 4. The Trouble with Testing: Suzanne  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

14. Belfast Health Advisers SSHA Conference 2008 Chapter 5. Two Days later: Maeve  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

15. Belfast Health Advisers SSHA Conference 2008 Chapter 6. Three Weeks Later: Claire  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

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

17. Belfast Health Advisers SSHA Conference 2008

18. Chapter 8. One Week later: Maeve  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.

19. Belfast Health Advisers SSHA Conference 2008 Chapter 9: A Collaborative Approach  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

20. Belfast Health Advisers SSHA Conference 2008 Lessons Learned: Further Collaboration Opportunity  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

21. Belfast Health Advisers SSHA Conference 2008 Final Chapter: Positive Outcomes:  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

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