1. Provincial HIV Collaborative Northern Health (NH) Smithers Team

2. Lee Anne Hodge Johnson Primary Care Developer Bulkley Valley Daphne Hart MD, General Practice, Smithers in collaboration with Jennifer Hawkes Northern Health Clinical Pharmacy Specialist in HIV Prince George

3. Geographic Isolation

4. Improvement Four Objectives set for Smithers Presentation of March 2011 HIV Primary Care Guidelines to Health Care Providers Access to Infectious Diseases Consultation by Telehealth Access to HIV Pharmacy Consultation by Telehealth Facilitate development of Multidisciplinary Integrated Team Based Care Four Objectives set for Smithers Presentation of March 2011 HIV Primary Care Guidelines to Health Care Providers Access to Infectious Diseases Consultation by Telehealth Access to HIV Pharmacy Consultation by Telehealth Facilitate development of Multidisciplinary Integrated Team Based Care

5. Improvement Objective that improvement relates to.... Access to Northern Health HIV Pharmacy consultation by Telehealth Objective that improvement relates to.... Access to Northern Health HIV Pharmacy consultation by Telehealth

6. Improvement Change tested that worked..... In July and August 2011 Three antiretroviral naive individuals had a consultation with the NH HIV Pharmacist by Telehealth prior to commencing antiretroviral medications. Prior to this time no direct Pharmacy consultation was accessible. Change tested that worked..... In July and August 2011 Three antiretroviral naive individuals had a consultation with the NH HIV Pharmacist by Telehealth prior to commencing antiretroviral medications. Prior to this time no direct Pharmacy consultation was accessible.

7. Improvement HIV Pharmacy Telehealth process involved 1. Use of Existing NH Telehealth infrastructure 2. Development of administrative forms HIV Pharmacy Telehealth Request form (Request for Telehealth, Referral to HIV Pharmacist System map of Blood Born Pathogens (BBP) Booking Process Memorandum of Understanding between NH Telehealth and the BBP Telehealth Initiative Group HIV Pharmacy Telehealth process involved 1. Use of Existing NH Telehealth infrastructure 2. Development of administrative forms HIV Pharmacy Telehealth Request form (Request for Telehealth, Referral to HIV Pharmacist System map of Blood Born Pathogens (BBP) Booking Process Memorandum of Understanding between NH Telehealth and the BBP Telehealth Initiative Group

8. 3. Sessional Physician in Smithers initiated the referral, attended to interview, facilitated patient attendance, provided the medical information in advance. 4. NH HIV Pharmacist in Prince George facilitated the Telehealth connection, conducted the interview, and provided a consultation letter for the referring physician and Family Physician. 3. Sessional Physician in Smithers initiated the referral, attended to interview, facilitated patient attendance, provided the medical information in advance. 4. NH HIV Pharmacist in Prince George facilitated the Telehealth connection, conducted the interview, and provided a consultation letter for the referring physician and Family Physician.

9. Challenge Move from a carefully orchestrated person dependent trial process to a sustainable process easily accessed by all Health Care Providers and individuals living with HIV in Smithers

10. Continuing Challenges Next Steps.... Await approval of forms by NH Document Centre Make forms available on NH intranet Spread awareness of access to the process Encourage follow up appointments Develop a sustainable plan regarding the roles and responsibilities for the process in Smithers Next Steps.... Await approval of forms by NH Document Centre Make forms available on NH intranet Spread awareness of access to the process Encourage follow up appointments Develop a sustainable plan regarding the roles and responsibilities for the process in Smithers

11. Lessons Learned Pharmacy consultation by Telehealth is possible Patients seemed engaged and there is interest in and support for the process Telehealth requires 48 hours notice. No urgent response. Video linked interviews offer something positive that telephone interviews cannot provide. Pharmacy consultation by Telehealth is possible Patients seemed engaged and there is interest in and support for the process Telehealth requires 48 hours notice. No urgent response. Video linked interviews offer something positive that telephone interviews cannot provide.

12. Lessons Learned The process developed for Smithers is applicable to other small rural communities in NH with Telehealth infrastructure. Meeting the objective of accessing Infectious Diseases consultation by Telehealth has been facilitated by the current work on accessing Pharmacy by Telehealth The process developed for Smithers is applicable to other small rural communities in NH with Telehealth infrastructure. Meeting the objective of accessing Infectious Diseases consultation by Telehealth has been facilitated by the current work on accessing Pharmacy by Telehealth

13. for Northern Health September 2011 Geographical isolation