How to investigate levels of Adherence to antiretroviral ... - INRUD

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Chapter 2 Core indicators of adherence When filling in the dispensing data collection form, alternate attendance indicators can be calculated easily. This means that we have two alternative attendance indicator: 6. Percentage of all visits in the last six months made before the medicine supplied at the previous visit have been consumed. 7. Percentage of all visits in the last six months made within three days of when the medicines supplied at the previous visit have been consumed. Indicator 4. Percentage of patients who attend on or before the day of their appointment Rationale Source of data Data collection Computation Comments Pitfalls Rate of missed appointments is one measure of programme success in actively engaging patients. Clinic or pharmacy records (if available). Based on the systematic sample of 100 patients, look at all scheduled appointments after the attendance four months prior to the date of data collection. Note: Only include those patients who attended during the month four months before data collection. (Number of patients appearing for appointment on or before day scheduled/number of patients in sample) × 100. Many programmes use different definitions of defaulting. The intention of this indicator is to identify a trigger point for programme action to reach out to patients at risk of defaulting. Some systems may not record the date of the next appointment. If this is the case, you can take the number of days of medicine dispensed and assume the last day is the day of the next appointment. Indicator 5. Percentage of patients who attend within three days of their appointment Rationale Source of data Data collection Computation Comments Some patients are given an extra two or three days of medicine. Therefore if they have missed their appointment by less than three days they may still be in treatment. This may serve to explain indicator 4. Same as 4—Clinic or pharmacy records (if available). Based on the systematic sample of 100 patients, look at all scheduled appointments after the attendance four months prior to the date of data collection. Note: Only include those patients who attended during the month four months before data collection. (Number of patients appearing within three days of their appointment/number of sampled patients) × 100. If programme routinely gives extra two or three days treatment, then this may be the appropriate trigger point rather than indicator 7. The intention of this indicator is to identify an alternative trigger point for programme action to reach out to patients at risk of defaulting. The different rates in different facilities are striking. Where a facility has a high percentage of patients attending on or before the day of their appointment, the likelihood of high adherence levels is increased. In the feasibility studies, the national medians varied from 72 13
How to Investigate Adherence to Antiretroviral Treatment: An Indicator-Based Approach to 96%, but in terms of facilities the lowest was 15%, meaning that only 15% of patients came on the day of their appointment. Sometimes the appointment dates are not available in the pharmacy notes making the two indicators above impossible to collect. Alternative attendance indicators are: 6. Percentage of all visits in the last six months made before the medicine supplied at the previous visit have been consumed. 7. Percentage of all visits in the last six months made within three days of when the medicine supplied at the previous visit have been consumed. With the method of filling in the dispensing form and recording all dates of visits in the last six months and numbers of days of pills dispensed, it is easy to automatically generate another two indicators which are approximate to indicators 4 and 5 above and take into account all the visits over the last six months rather than only looking at one. Alternative attendance indicator 6 is: Indicators 6 & 7. Percentage of all visits in the last six months made before the days of medicine supplied at the previous visit have been consumed and within three days of the drugs being consumed Rationale Source of data Data collection Computation Comments Rate of attendance before medicine is finished and within three days of the medicines being finished are measures of treatment adherence and one measure of programme success in actively engaging patients. Pharmacy records. Based on exactly the same data as collected for indicators 2 and 3 above which was based on the sample of 100 patients and used historical dispensing data in pharmacy records. The date and days’ supply of all ARVs dispensed during the index visit and during all subsequent visits for this patient during the follow-up period chosen should be recorded. Using the spreadsheet analysis tool the computation can be made for the sample of patients. (Number of appointments attended on or before pills ran out/total number of appointments sampled) × 100. (Number of appointments attended within three days of pills running out /total number of appointments sampled) × 100. To calculate this indicator, the spreadsheet analysis tool is needed. 14
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