Tracking Adherence: A Multidisciplinary Approach

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Tracking Adherence A Multidisciplinary Approach
International Center for AIDS Care and Treatment
Programs Annual Meeting, March 2006 Dar Es
Salaam, Tanzania

• Maaza Seyoum, Nancy Beam, Sara Casey
• ICAP Rwanda
• 8 March 2006

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Multidisciplinary Team

• Nurse pharmacists
• See patients each month
• Assess adherence
• Social workers
• Conduct initial psychosocial assessment and
  in-depth counseling
• Conduct home visits
• Make referrals and coordinate with community
  volunteers and associations of PLWHA
• Consultation clinicians
• Confirm lab appointments kept
• Reinforce adherence

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Patient Appointment Card

• Patients receive a card that records all
  appointments
• Medical
• Pharmacy
• Counseling
• Helps patient remember his/her appointments
• Allows team members to remind patients of
  upcoming appointments with another provider

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Missed Appointments

• Challenging to easily identify missed
  appointments
• Pharmacy had reasonable system
• Medical, lab and counseling appointments
  impossible to trace without looking through
  individual patient files
• Primarily paper-based systems
• Little electricity or capacity for electronic
  system especially in health centers

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Agendas

• Consultation room
• Psychosocial team

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Pharmacy

• Agenda to record next pharmacy appointment

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Individual Pharmacy Record
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Pharmacy Appointment Tracking

• Record next visit
• Note if appointment date was respected

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Adherence and Other Appointments

• Ask about missed doses and pills left
• Note date of next medical appointment

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Tracking Missed Appointments

• Agendas can see at the end of each day who
  missed appointments
• List of patients who missed appointments given to
  social worker
• Conducts and documents home visit
• Links with case manager or CHWs to visit patients
  who live far away
• SW sets aside one day per week for home visits

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Missed CD4 Appointments

• Pre-ART and ART registers organized by month
• Easy to see who is missing a CD4 control after 6
  months

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Tracking Missed CD4 Appointments

• List of patients on ART or Bactrim given to
  pharmacist
• Marks individual patient record
• Asks patient at next pharmacy visit
• List of patients not on medication given to
  social worker
• Conduct home visits, link with CHWs, case
  manager, associations of PLWHA to track down
  patients

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Results

• Loss to follow up of ART patients is low
• 18 of 3,000 patients, 0.6
• Remaining questions
• How is patients adherence to their ARVs?
• What is LTFU of non-ART patients?
• Analysis of data from new tools in 6 months to
  answer these questions

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Conclusion

• Challenges
• Prioritizing patients to visit
• Long distances to patients homes
• Transport for home visits
• How do we define LTFU for non-ART patients?
• Analysis of data from new tools
• Requires multidisciplinary team to work together
  (weekly team meetings)
• Tracking missed appointments with paper-based
  systems can be successful