SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements:
Volume 1, Issue 10 (August 24, 1996)

Information dissemination from 27 Innovative Models of HIV Care projects funded as Special Projects of National Significance by the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA).

Introduction

Welcome to SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements. In each issue of SPNS/Fax, we will highlight findings from the HRSA Special Projects of National Significance Program Cooperative Agreements. The projects have been funded to develop innovative models of HIV/AIDS care. SPNS/Fax reports are distributed every two weeks by fax machine to all subscribers. All issues of SPNS/Fax are also available at this Web site. Due to slight differences in the media, issues distributed by fax machine may appear slightly different from those posted on this Web site, but the content is identical.

University of Washington Project Improves Understanding of HIV/AIDS Patients' Delirium

The University of Washington's project developed a model for training and education on neuropsychiatric disorders, especially delirium, affecting many HIV/AIDS patients. Delirium is characterized by disturbances in consciousness, an inability to control attention, and memory disturbances. Delirium has a rapid onset and is caused by several physical factors such as medical problems or medication use. Two aspects of the project are particularly innovative. The focus is on delirium, which has not been extensively studied with HIV/AIDS patients, although it is believed to be a prevalent problem. An additional focus of the project is on helping family members understand delirium. This is especially important since family members often assume the role of care providers.

This study has several important features, including: documentation of the incidence rate of delirium on HIV/AIDS skilled nursing facility patients; use of actual patient records in the diagnosis; and documentation of correlates to delirium which has several implications for the standards of practice.

To assess the extent of the need for training and education, the project reviewed medical charts of skilled nursing facility (SNF) patients diagnosed with HIV/AIDS. The major purpose of the review was to determine the frequency of delirium occurrences, stage of patients' care when delirium occurred, the extent to which these occurrences were formally diagnosed as delirium, and the type of treatments received immediately before and after an incident of delirium.

Participants in the study were skilled nursing facility patients. Most of the patients were male (98%) and Caucasian (80%). The average age was 37 years old. HIV exposure for a majority of the patients was through sex (64%) and a minority through injection drug use (IDU: 9%), IDU and sex (7%), or other sources (16%). Most of the study's patients died (88%) at the facility.

There were several compelling results. While 63 of the patients (46%) experienced delirium, only one patient was actually diagnosed as such. Occurrence of delirium was most likely in the days prior to death. The next most frequent time of occurrence was around the time of admission. Patients with delirium (although usually not diagnosed as such) were much more likely to be treated with benzodiazepines, anticholinergics, or narcotics than patients not experiencing delirium (see left).

The findings of this study were presented at the XIth International Conference on AIDS (Uldall, Berghuis, & Lalonde, 1996) and are being prepared for publication.

Having documented the degree of the lack of knowledge and attention given to delirium by health care providers, the project has focused subsequent efforts on education and training. Training has included monthly didactic presentations or case discussions at participating hospitals and clinics and psychiatric screening. In addition to training directed toward hospital and clinic health care providers, the program provides monthly educational counseling to the families and clients. The program also has developed an instructional videotape, which is currently being used to further educate health care providers on delirium in HIV/AIDS patients, and will be made available more broadly in the near future.

For more information, contact Dr. Karina Uldall at the Center for AIDS and STD, University of Washington,  901 Boren Ave., Suite 1100, Seattle, WA 98104; 206.221.4944 (phone), 206.221.4945 (fax); or by email at keegan@u.washington.edu.

SPNS/Fax is produced by The Measurement Group–PROTOTYPES Evaluation and Dissemination Center (EDC). Editorial comments should be made to The Measurement Group at 5811A Uplander Way, Culver City, California 90230, 310.216.1051, 310.670.7735 (fax).
 

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