title: Implementation of HIV Palliative Care: Interprofessional Education to Improve Patient Outcomes in Resource-Constrained Settings, 2004-2012.
abstract: Palliative care (PC), introduced early in the management of chronic illness, improves patient outcomes. Early integration of a palliative approach for persons with HIV has been documented to be effective in identifying and managing patient-level concerns over the past decade in African settings. The experience of implementing PC in multiple African and other resource-constrained settings (RCSs) emphasizes the need for essential palliative competencies that can be integrated with chronic disease management for patients and their families facing life-limiting illness. This article is an historical description of how basic palliative competencies were observed to be acceptable for health workers providing outpatient HIV care and treatment during eight years of U.S. implementation of "care and support," a term coined to represent PC for persons living with HIV in RCS. The need for team building and interprofessional education is highlighted. The model is currently being tested in one U.S. city and may represent a mechanism for expanding the palliative approach into management of chronic disease. Such competencies may play a role in the development of the patient-centered medical home, a critical component of U.S. health care reform.
authors.affiliation: Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA. Electronic address: calexand@medicine.umaryland.edu.
authors.forename: Carla S
authors.initials: CS
authors.lastname: Alexander
authors.affiliation: George Washington University, Washington, DC, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Pappas
authors.affiliation: Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Amoroso
authors.affiliation: University of Maryland School of Nursing, Baltimore, Maryland, USA.
authors.forename: Mei Ching
authors.initials: MC
authors.lastname: Lee
authors.affiliation: State of Maryland Department of Health and Mental Hygiene, Catonsville, Maryland, USA.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Brown-Henley
authors.affiliation: Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Memiah
authors.affiliation: Johns Hopkins Oncology, Baltimore, Maryland, USA.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: O'Neill
authors.affiliation: European Health Management Association, Brussels, Belgium.
authors.forename: Olivia
authors.initials: O
authors.lastname: Dix
authors.affiliation: Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Redfield
mesh_terms: D000349:Africa; D002908:Chronic Disease / Q000191:economics / Q000628:therapy; D004517:Education, Professional / Q000191:economics* / Q000379:methods*; D015658:HIV Infections / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D006282:Health Personnel / Q000193:education / Q000523:psychology; D006295:Health Resources; D006699:Home Care Services / Q000191:economics; D006801:Humans; D010166:Palliative Care / Q000191:economics* / Q000379:methods* / Q000523:psychology; D018802:Patient-Centered Care / Q000191:economics / Q000379:methods; D011379:Prognosis; D016896:Treatment Outcome; D014481:United States
keywords: HIV/AIDS; interprofessional education; palliative care; patient centered; resource constrained