HIV service
From the time when antiretroviral (ARV) treatment found its way to the United Kingdom, it has resulted in a profound influence on the lives of people living with HIV as well as AIDS (Dunbar 2011). There has been a significant decrease in the number of individuals dying from AIDS. On the other hand, in spite of the availability of free ARV treatment, there are yet individuals dying from AIDS-associated sicknesses in the UK. Late diagnosis greatly augments the possibility of death. A twelve-year study (from 1997 to 2008) of deaths because of HIV in the UK revealed that three-quarters of deaths associated with AIDS over the time studied happened because the victims had a late diagnosis (Dunbar 2011).
Prior to the start of ARV treatment, there was very little to do to prevent the progression of HIV to full-blown AIDS (Dunbar 2011). Existence was limited (life expectancy was limited) and management of opportunistic diseases was mainly intended to control pain and additional symptoms. While the initial AIDS instances were accounted for in the UK at the start of the 1980s, most of the AIDS patients passed away within a period of two years (Dunbar 2011). The circumstances began to get better during the mid-1980s with the discovery that individuals with HIV and AIDS had a longer life expectancy after taking antiretroviral drugs and receiving other forms of necessary health care (Dunbar 2011).
Statistics distributed by the Health Protection Agency (HPA) illustrate that from the 1990s, the number of people living with HIV and accessing HIV services and care in the UK has considerably increased. In the UK, approximately 18,000 individuals were receiving HIV services in the year 1998, and this figure had more than tripled by 2007 (Dunbar 2011). Nevertheless, among people with highly developed HIV infection, people with below 350 cells/mm3 of CD4 count, nearly one in every five, were not getting treatment. Apart from late diagnosis, drug resistance has as well influenced the rate of continued survival amid people living with HIV in the UK (Dunbar 2011). Two main reasons underscore why there is a noteworthy augment in the number of individuals obtaining HIV services. Firstly, there has been a great reduction in HIV-associated deaths thanks to the introduction of ARV treatment. People with HIV are living longer and hence need health care for longer (Dunbar 2011). Secondly, there has been a rise in the number of fresh HIV diagnoses attributable to ongoing sexual transmission, an augment in testing, and migration of HIV-positive people because of stigmatization in some places (Varni et al. 2012).
Description and critical evaluation of its performance in relation to accessibility
The impact of primary health care (PHC) in the handling of HIV/AIDS has been revealed among infected people in the UK (Kalichman et al. 2011). Useful involvements comprise the consideration of risk and willingness by patients to adjust, motivational involvements by health providers for the wellbeing of patients, and referral of appropriate patients for additional intensive involvements. Motivational involvements play a key role in ensuring the appropriateness of health care. With respect to HIV services in the UK, health checks have been shown to better preventive care along with support for performance change (Kalichman et al. 2011). Nevertheless, their influence on health results is tentative. The concentration of health checks ought to be on particular evidence-based preventive activities and entail the application of normalized resources like life scripts (evidence-based tools that enable the general practitioners to tackle the major lifestyle risk factors like poor nutrition), as well as integrated health risk evaluation tools (Kalichman et al. 2011).
General practice referral involving patients requiring additional intensive lifestyle involvements is frequent because of a number of aspects that include the availability of services and providers coupled with the integration involving these services along with primary health care. The key function of primary health care establishments is to organize and broker a system of referral services in a bid to maintain behavior change anchored in standards in addition to quality guarantee (Kalichman et al. 2011). Additional key functions of primary care comprise practices to check and advance their performance in offering preventive care. Nonetheless, structural modification of primary health care could offer chances for additional combined advances to the administration of the lifestyle risk features across public and non-public services (Kalichman et al. 2011).
In the UK, primary health care occurs most commonly in the broad practice situation under the watch of practice nurses along with allied health providers (Anstee et al. 2011). The broad practice offers care across the range from prevention of disease to management and rehabilitation and provides a range of consultations to roughly eighty-six percent of people in the UK every year (Anstee et al. 2011). In the UK and mainly in HIV services internationally, the central feature of primary care is accessibility. Accessibility denotes first contact. With respect to accessibility, apart from taking care of the requirements of individuals, PHC teams as well focus on society (Anstee et al. 2011).
In addition, making HIV services free is significant to ensure affordability for all. Equity connects closely to effectiveness: execution of evidence-based medication, bearing in mind that background proof and strategy sign might contribute to additional health and additional equity (Meads et al. 2006). Besides funding and employment, excellence of care has to be maximal. In the UK and all over the globe, but particularly in developing nations, there is a difficulty for enrolment and maintenance of PHC providers, mainly nurses and doctors. In the UK, there is a move of workforce from the regional PHC method in the direction of vertical disease-based line-ups (Meads et al. 2006).
Furthermore, there is a move from rural localities and settlements towards more wealthy localities in cities. Internationally, there is rising migration of health caregivers from third world nations to nations offering higher income. Decentralization is a requirement in order to improve equity in the provision of PHC. Currently, there exists an agreement that the most suitable model for the administration of services in health care uses the district health structure, viz. the geographical incorporation of treatment centers, clinics, and hospitals. Innovative organization policies are vital to tackle the concerns of every stakeholder successfully while initializing the district health structure (Meads et al. 2006).
Successes and problems
A study on the replacement of physicians by nurses in PHC revealed that suitably trained nurses could provide excellent care and realize high-quality patient health results (Siegrist & Marmot 2006). In this study, nurses comprised practice nurses as well as medical nurse specialists and nurse practitioners, thus demonstrating that for success in primary health care, the general practice group can develop to comprise nurses with responsibility in HIV prevention and management. Consequently, there has been a longer lifespan for HIV-positive people (Siegrist & Marmot 2006). However, the number of individuals living with HIV has tremendously increased. In the United Kingdom, practice nurses play a key role in general practice by assisting and performing part or the entire health checks. These roles may comprise of discovering patients that are suitable for health checks, evaluating their combined risk score and risk aspects, offering motivational counseling, edification and discussing behavioral objectives, and organizing follow up (Siegrist & Marmot 2006).
Factors that contribute to the success or poor performance
In PHC, brief interventions might be inadequate to attain and sustain the intensity of behavioral and physiological change necessitated in the prevention and management of chronic diseases (Siegrist & Marmot 2006). Presently, general practitioners presently infrequently submit to programs, providers, and services due to a combination of factors comprising GP mindsets, availability, communication, and helpful restrictions. In primary health care, developing a more inclusive system of referral services as well as programs to maintain behavior change of all people is a factor that contributes to the desired success (Siegrist & Marmot 2006). This would include education programs on safe sex practices.
This aspect should hinge on values, be brokered by prevailing primary health care services, and be quality guaranteed (Siegrist & Marmot 2006). For success, the function of practice nurses in offering interventions might require to be increased depending on local needs (particularly in the non-availability of allied health providers). Even though vertical programs are not free (illness-oriented), there has been poor performance in the illness control programs (Siegrist & Marmot 2006). In a bid to handle the drawbacks of vertical programs, a system of best practices for HIV management programs has been set up. There is a necessity to incorporate programs into regional health facilities with the aim of realizing a reasonable view for successful illness control (Siegrist & Marmot 2006).
The implications for PHC providers, consumers, and the rest of the health system
The life scripts programs have extended a set of resources intended to maintain concise interventions of PHC providers in terms of education and routine recommendations just to mention a few (Douglas et al. 2006). Health systems must thus employ life scripts as a structure for all materials aimed at sustaining brief interventions in PHC. Nevertheless, these materials should be accessible electronically and be incorporated with practice software structures for them to be extensively approved.
Health-risk evaluation devices are constructive even if evaluation researches are presently ongoing. Existing evidence recommends that these devices should be connected with advanced excellence of preventive care (Douglas et al. 2006). Nevertheless, the varied choice of health-risk evaluation devices might confuse PHC providers and obstruct their more extensive adoption. Downsizing provider health-risk evaluation devices and guaranteeing integration of devices intended for consumer application and those employed by PHC professionals is vital for the successful application of these tools.
The equity implications
Socially deprived people (such as indigenous Australians) are at a higher risk with respect to chronic diseases. Generally, socially deprived people in society have limited access to PHC largely due to systemic problems like the high backlogs of general practitioners operating in these areas. Successful policies to enhance access and equity comprise reducing costs, giving outreach and culturally suitable services, and promoting health literacy (Varni et al.2012). A necessity for stronger ties between PHC and public health services will guarantee access to healthy alternatives. PHC providers should be discouraged from asking for illegal charges from people for preventive care and encouraged to give services that are in line with the set.
Opportunities for change
Many General Practices are presently actively engaged in promoting practices to develop the administration of behavioral risk aspects, providing practices application of life scripts, utilizing or brokering personal providers and team programs for livelihood modification, and connecting with health services (Varni et al.2012). There is an opportunity to extend performance pointers for PHC administrations in particular concentrated on the evaluation and administration of behavioral risk aspects in people at risk of getting chronic diseases. Additionally, the position of primary health care has an opportunity for development in organizing individual and team referral programs for the risk aspects (Varni et al.2012).
However, based on the current innovations that are being done in the health care sector, it is evident that more and more complex processes are expected thus calling for health care professionals to heighten their skills in a bid to catch up with the ever-advancing technology. As such, a lot of training is needed for all health care experts since the handling of patients is advancing from the old manual procedures to contemporary technology-oriented techniques. There exist numerous unanswered questions concerning the task of PHC in preventing and managing chronic diseases. Presently, research is in progress to assess the influence of programs that incorporate health evaluations, concise interventions, as well as referral services (Anstee et al. 2011). More unanswered questions touch on shaping the optimal equilibrium between opportunistic and organized health evaluations (health checks).
Recomendations
- For financial incentives to promote preventive care, evaluation should unanimously align with preventive interventions concentrating on people at higher risk in a bid to ensure simplicity in its administration.
- Reforms to PHC are necessary to generate chances for a greater integrated advance of health care. For instance, patient enrolment could allow a clear definition of accountability for preventive care and permit practices to recognize the people they are accountable for during care delivery.
References
Anstee, S, Price, A, Young, A, Barnard, K, Coates, B, Fraser, S & Moran, R 2011, ‘Developing a matrix to identify and prioritize research recommendations in HIV Prevention’, BMC Public Health, vol. 11 no. 4, pp. 381-388.
Douglas, F, Teijlingen, E, Torrance, N, Fearn, P, Kerr, A & Meloni, S 2006, ‘Promoting physical activity in primary care settings: Health visitors’ and practice nurses’ views and experiences’, Journal of Advanced Nursing, vol. 55 no. 2, pp. 159-168.
Dunbar, D 2011, ‘People with AIDS (PWA) Since Highly Active Antiretroviral Therapy, 1996,’ Journal of Medical Humanities, vol. 32 no. 2, pp. 115-125.
Kalichman, S, Cherry, C, White, D, Jones, M, Grebler, T, Kalichman, M, Detorio, M, Caliendo, A & Schinazi, R 2011, ‘Sexual HIV Transmission and Antiretroviral Therapy: A Prospective Cohort Study of Behavioural Risk Factors Among Men and Women Living with HIV/AIDS’, Annals of Behavioural Medicine, vol. 42 no. 1, pp. 111-119.
Meads, G, Wild, A, Griffiths, F, Iwami, M & Moore, P 2006, ‘The management of new primary care organizations: an international perspective’, Health Services Management Research, vol. 19 no. 1, pp. 166-173.
Siegrist, J & Marmot, M 2006, Social Inequalities in health: new-evidence and policy implications, Oxford University Press, Oxford.
Varni, S, Miller, C, McCuin, T & Solomon, S 2012, ‘Disengagement and Engagement Coping with HIV/AIDS Stigma and Psychological Well-Being of People with HIV/AIDS’, Journal of Social & Clinical Psychology, vol. 31 no. 2, pp. 123-150.