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The Dispensing Based Retrospective Data Collection

Adherence Assessment Survey

Dispensing 1

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The Dispensing-based Retrospective Data Collection

The main purpose of this exercise is to find all the adherence indicators except the self report of the exit interview.

As such, it is the single most important exercise of the survey.

Dispensing 2

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Sampling 100 Patient Records

The goal is to follow 100 patient records for six months

Therefore, the sample should be of patients who attended eight months before

For example, the data collection is during October, so sample patients who attended during March

If the patient attended end of March, then six months is completed at the end of September

It is advisable to sample 120 records to end with 100 usable ones

Dispensing 3

Sampling 100 Patient Records

Survey Data Collection Month

Retrospective Sample Month the Previous

January JuneFebruary July

March AugustApril SeptemberMay OctoberJune NovemberJuly December

August JanuarySeptember February

October MarchNovember AprilDecember May

Dispensing 4

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Retrospective Sampling Methods—Examples of Different Situations

Functioning attendance register and patient identification numbers

There is an attendance register, but it does not distinguish between those on ART and those not on ART. However, there is an ART Initiation Register

There is no attendance register, and no ART Initiation Register, but patient identifier number is in order of initiation

There is no attendance register, no ART Initiation Register, and patient identification number is not in order of ART initiation.

Dispensing 5

Methods of Retrospective Sampling-1

Functioning attendance

register and patient identificationnumbers

Yes

Yes

There is an attendanceregister, but it does notdistinguish between

thoseon ART and those not

on ART—however, there is

anART Initiation Register

Randomly sample patients on ART attending in the relevant month and write their name and number on the patient identification sheets. Then pull their pharmacy records.

If most patients are seen every month use ART initiation register. Evenly sample from all the patients who have initiated ART from when the clinic started to up to the end of the month you are sampling.

As a last resort—sample many more than 120 from the attendance register to end up with 100 patients on ART

No

Dispensing 6

No

Methods of Retrospective Sampling-2

There is no attendance register, and no ART Initiation Register, but patient identifier number is in order of initiation

Yes

No

Yes

No

No attendance register, no ART Initiation Register. The patient identification numbers are not allocated in order of ART initiation.

Check how the pharmacy and clinical notes are stored.

If stored in patient identifier order numbers find which number had started by the end of the month for which you are interested and sample all patients who had started before then.

Check the total number of patients on ART now. Check the total number that were on ART 7 months before. Sample from all patients. Sampled size should correspond to the proportion patients started before the end of the month you are interested in.

Dispensing 7

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Retrospective Sampling methods

Any set of circumstances may be met in practice

So far (after 80 facilities in 4 countries), it has always been possible to devise a sensible system for sampling records

You may need to be creative The key is to understand the recording and

storage systems for both the pharmacy records and the attendance register information

Dispensing 8

Retrospective Form

Retrospective Dispensing Data

Date of Entry Facility names

A B C D E G H

Seq.

No.

Patient identifi

er

   Initiation of ARVs

Index Visit Dispensing

Age in Yrs at index visit

Gender M/F Date

initiation ARVs

Index visit Date any ARV drugs dispensed

(dd/mm/yy)

# days of ART

dispensed on that

day

1            

2            

3            

Dispensing 9

Take the manual (Chapter 4) and go over filling in the form, column by column.

Retrospective Form

FACILITY #

Name Data Collector

J K N O

Visit 2 Dispensing Visit 3 Dispensing

Date any ARV drugs dispensed

(dd/mm/yy)

# days of ART

dispensed on that day

Date any ARV drugs dispensed

(dd/mm/yy)

# days of ART

dispensed on that day

       

       

       

Dispensing 10

Retrospective Form

BX BY BZ CA

  If yes If missed If missed

Did patient

attend 3 months

ago (Y/N)

Attended next appt after visit 3 months ago (Y/N)

Attended in next 3 days

after missed appt

(Y/N)

Attended in next 30

days after missed visit

(Y/N)

       

       

       

Dispensing 11

Looking at Attendance

The longest appointments are for three monthsThis means we want to look at the appointment

more than three months ago. For example, the data collection is during

October Look at attendance during June Find what date the next appointment was given

during this attendance Look at actual attendance and decide whether it

was on or before the due date, within 3 days and within 30 days of due date and fill in accordingly

Dispensing 12

Looking at Attendance

Survey Data Collection Month

For the Appointment after the Attendance month the previous

January SeptemberFebruary October

March NovemberApril DecemberMay JanuaryJune FebruaryJuly March

August AprilSeptember May

October JuneNovember JulyDecember August

Dispensing 13