QUOTE TB Light

Sara Massaut, Senior Project Officer, TB CAP/KNCVACSM sub-working group meeting November 30 and December 1, 2009

Cancun, Mexico

Contents

• Introduce QUOTE-TB Light—a patient centered approach

• Experiences from the field (Nigeria)

• Issues and the wayforward

Background

• Quality Of Care Through the Eyes of the Patient

• Developed and piloted in Kenya, Malawi, Uganda Published 2007

• Collaboration betweenKNCV, KIT, NIVEL andRCQHC

QUOTE-TB

• To measure performance of health services through the eyes of the patient weighted by what patients find important..

• Experience showed that application was complex with a strict scientific andcostly approach.

• Develop QUOTE-TB Light

What is QUOTE TB Light?

• More user-friendly application of the original QUOTE-TB

• A “ready to use” packagewith standardized instruments for application• Pictogram cards to

measure importance• Questionnaire to

measure performance• Data entry worksheet to

calculate Quality Impact

Quality Dimensions

• Communication and Information• Professional Competence• Availability of services• Patient provider interaction and

counseling• TB/HIV relationship• Support• Infrastructure• Stigma• Affordability

QUOTE TB-Light in three steps

Step 1: Establish theImportance ranking score ofnine quality dimensionsthat are important to patients(FGD).

Step 2: Establish thePerformance score for TBcare as provided by thehealth facility (IndividualInterviews)

Step 3: Calculate thequality impact scores of theTB care. (Importance score XPerformance score X 10)

Set up of Field test in Nigeria

• Three weeks in with two teams: TB Three weeks in with two teams: TB CAP, NTBLCP, State Supervisor and CAP, NTBLCP, State Supervisor and ILEP ILEP

• 8 facilities—one per day—in four 8 facilities—one per day—in four States.States.

• 4 FGDs with average 8 patients 4 FGDs with average 8 patients eacheach

• 77 individual patient interviews to 77 individual patient interviews to assess performance of health assess performance of health facilitiesfacilities

Results 1

Quality Dimensions and TB Care Services

ImportanceScore

PerformanceScore (% negative

responses)

QualityImpact>0.75

Affordability 61%

No Pay for TB services 61% 0% 0.0

No tip for TB services 61% 0% 0.0

Professional Competence 83%

Home based TB treatment 83% 65% 5.4

Contact tracing 83% 61% 5.0

Support 47%

Support for transport 47% 100% 4.7

Support for food 47% 100% 4.7

Results 2

Quality Dimensions and TB Care Services

ImportanceScore

PerformanceScore (% negative

responses)

QualityImpact>0.75

Communication andInformation 94%

Drug side effects 94% 40% 3.8

Stop spreading TB 94% 34% 3.2

Stigma 17%

Stigmatizing communication 17% 5% 0.09

Welcoming atmosphere 17% 3% 0.04

Summary findings Nigeria

• Health Education is a major issue to be addressed—informing about and understanding illness is essential.

• Providing food and transport support is important to TB patients; what are feasible interventions for TB programs?

• Stigma does not seem to be a big issue

Issues and Way Forward

• Application during routine supervision vs OR approach?

• Patients who do not come to the facility for care are not included.

• Translating results into interventions? • Patient involvement• District level vs national

Loose EndsLoose Ends• Introduction during Introduction during

Patient Centered Patient Centered Approach session on Approach session on Dec 4 from 9-12 Dec 4 from 9-12 at the Fiesta America Grand Coral Beach Hotel (Coral Gallery 1C)

• Send questions and Send questions and experiences of use to experiences of use to Sara Massaut at Sara Massaut at massauts@kncvtbc.nlmassauts@kncvtbc.nl

• www.tbcta.orgwww.tbcta.org

AcknowledgementsAcknowledgements

Dr. Mansur Kabir, NTBLCP Jumoke Onazi, TB CAP NigeriaEmmy van der Grinten, TB CAP NigeriaSani Useni, NLRTolu Oguntimehin, TLMAbebayo Peters, NTBLCPApanda Goje, Kaduna STBLCPTB Patients in Kaduna, Kwara, Bauchi and Abuja thatparticiapted in field testing

Jacques van der Broek, KNCVAnke van der Kwaak, KITHerman Sixma, NIVEL