decreasing number of patients - maksph … number of...decreasing number of patients lost to follow...
Post on 26-Aug-2018
219 Views
Preview:
TRANSCRIPT
DECREASING NUMBER OF PATIENTS LOST TO FOLLOW UP AT FHCJ
FELLOWS Joe Collins OPIO Michael KAKINDA
SUPERVISORS DR. Alex Riolexus ARIO DR. Carole SEKIMPI
DECREASING NUMBER OF PATIENTS LOST TO FOLLOW UP AT FHCJ
FELLOWS Joe Collins OPIO Michael KAKINDA
SUPERVISORS DR. Alex Riolexus ARIO DR. Carole SEKIMPI
BACKGROUND I • Family Hope Centre Jinja(FHCJ) Fund(CAF)‐Uganda Clinic
• CAF’s mission goal is to HIV disease to children and
• FHCJ serves clients from the focus are patients within the facility.
BACKGROUND I Jinja(FHCJ) is a Children’s AIDS Clinic.
to limit suffering caused by and their families.
from all over the country but within a 40 km radius from
BACKGROUND II • CLINIC STATSTICS ( as of 30
Total No of Patients
No on HAART
No on G/C
Adults in care
Children in care
BACKGROUND II CLINIC STATSTICS ( as of 30‐06‐2012)
2916
2485
431
2685(90.4%)
281(9.6%)
PROBLEM STATEMENT I • Initially little emphasis was
it was time for preparing
the donor.
• The pts. who had accumulated
would be called up to categorise
dead, transferred out or
• Then an attempt would
near the 90 day mark.
PROBLEM STATEMENT I was placed on pts. LTFU till
preparing the quarterly reports to
accumulated over 90 days
categorise them as either
or LTFU.
be made to contact those
PROBLEM STATEMENT II • During the fellowship
patients who miss their
• But due to practical reasons
intensify 14 days after
appointment.
• These patients could either out or will be LTFU. Pts
are at high risk of mortality
PROBLEM STATEMENT II fellowship we were monitoring
appointments daily.
reasons the follow up would
the pt. has missed their
either be dead, Transferred
Pts. LTFU and not on ARV’s
mortality and morbidity.
OBJECTIVES MAIN OBJECTIVES • Decrease the number of
their appointments > 14 reduce the number of patients
SPECIFIC OBJECTIVES • Redefine the M&E timelines
their appointments from quarterly • Increase the number of
appointments from the current 2012.
• Incorporate the monitoring who miss their appointments
OBJECTIVES
patients who have missed days by 75% in a bid to
patients eventually LTFU.
timelines for those who have missed quarterly to daily. of patients who keep their current 90% to 95% by June
monitoring and follow‐up of patients appointments in the daily clinic events.
INTERVENTIONS I PROBLEM DRIVERS INTERVENTIONS
Increasing Number of Patients LTFU
Improper systems of monitoring patients LTFU
The files are withdrawn the day before the patients appointment.
The patients who have missed their appointments are called that day.
INTERVENTIONS I INTERVENTIONS PROCESSES BEFORE
INTERVENTIONS
The files are withdrawn the day before the patients appointment.
Files withdrawn when patient came for care.
The patients who have missed their appointments are
day.
The patients LTFU followed up when preparing the quarterly report.
INTERVENTIONS II PROBLEM DRIVERS
Increasing number of patients lost to follow up.
Improper system of monitoring patients LTFU
INTERVENTIONS II INTERVENTION PROCESS BEFORE
INTERVENTION Updating patient’s phone numbers and socio‐demographics.
Phone numbers were only updated when the patient reported a change in numbers.
Appointment days have been incorporated into the patient database.
The patient database used the pill count to approximate the appointment day.
An SMS remainder was being sent automatically from the database a day to the appointment.
Most of the patients who missed their appointments used to claim they forgot.
PROJECT OUTCOMES I • The number of clients
appointments > 14 days
2012 from the 51 in July
• The number of patients
per month yet it used to
month.
• The average % of patients
appointments Increased
2012 to 94.76% at the end
PROJECT OUTCOMES I clients who are missed their
days are now 10 as of June
July 2011.
LTFU is now an average 1
to be an average of 6 per
patients who kept their
Increased from 90.87% in February
end of the project.
A line graph showing the number of clients that missed ARV’s by > 14 days and Number of clients lost to follow
up from Jul‐2011 to June 2012
A line graph showing the number of clients that missed ARV’s by > 14 days and Number of clients lost to follow
2011 to June 2012
Key Challenges • It was initially difficult to win
give the project full backing.
We had to go through
them. The decrease in the
help.
• Most patients were not providing
it was difficult to do a home
found not to be reliable.
We had to re‐audit all existing
win over Senior management to
through the CQI principles with
the patients LTFU also did
providing clear home directions so
home visit if their contacts were
existing home direction forms
LESSONS LEARNT
• Team work is paramount since very body brings on board different expertise.
• Simple system checks can go a long way in
improving the quality of care offered.
LESSONS LEARNT
Team work is paramount since very body brings on board different expertise.
Simple system checks can go a long way in
improving the quality of care offered.
STANDARDIZATION
• We have been able monitoring patients who appointments.
• Monitoring patients appointments is now part the clinic.
• There has been an incorporation used to monitor the patients their appointments into monitor the programme
STANDARDIZATION
to develop S.O.P’s for who have missed their
who missed their part of the daily fabric of
incorporation of the tools patients who have missed
into those which are used to programme.
FUTURE PLANS
The CQI team is re‐evaluating the project with
eventual replication to other facilities. This
evaluation will inform senior management to
tailor future projects to suite other facilities.
FUTURE PLANS
evaluating the project with
eventual replication to other facilities. This
evaluation will inform senior management to
tailor future projects to suite other facilities.
CONCLUSION
• This project was number of patients LTFU
• We were able to patients who missed
• The number of patients appointments increased 94.76% by the end of
CONCLUSION
able to decrease the LTFU by 83.3%.
reduce the number of missed by >14 days by 80.4 %.
patients who kept their increased from 90.84 % to
of the project.
Acknowledgment
• Makerere School of Public Health
• Management of Children’s Aids Fund
• Mentors
• CQI fellows
cknowledgment
Makerere School of Public Health‐CDC Staff
Management of Children’s Aids Fund
“Quality is not a noun,
process, Quality requires measuring,
retooling over and over again”
Richard D. Farrar
Vice President, Owner and Franchise Services
Marriott International, Inc.
Washington D.C
but a verb, an action, a
measuring, monitoring and
again”.
Vice President, Owner and Franchise Services
top related