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

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Chapter 3 Indicators for possible determinants of adherence 14. ARV dispensing rate—Percentage of patients who had all prescribed ARVs dispensed at the health facility. Rationale Source of data Data collection Computation Comments Failure to dispense, during the patient visit, all ARVs that were prescribed is a primary barrier to adherence. Patient exit interviews. For sample of 30 patients attending on day of data collection (or all patients if < 30 attend that day), check to see if all ARVs prescribed were dispensed. (Number of patients dispensed all ARVs prescribed/number of patients surveyed) × 100. Need to ask if patients were told to fill prescription outside of health facility or to return earlier than usual to pick up additional ARVs. 15. Non-ARV medicines dispensing rate—Percentage of patients who had all prescribed medicines dispensed at the health facility. Rationale Source of data Failure to dispense during the patient visit all non-ARV medicines prescribed can contribute to overall low adherence. Patient exit interviews. Data collection For sample of 30 patients attending on day of data collection (or all patients if < 30 attend that day), check to see if all non-ARV medicines prescribed were dispensed. Computation Comments (Number of patients dispensed all non-ARV medicines prescribed/number of patients surveyed) × 100. Need to ask if patients were told to fill prescription outside of health facility or to return earlier than usual to pick up additional non-ARV medicines. 16. Proper medicines labelling—Percentage of patients for whom all medicines dispensed are adequately labelled. Rationale Source of data Data collection Computation Comments Proper labelling of all medicines promotes better knowledge about their use and is essential for patient safety. Patient exit interviews. Based on a sample of 30 patients attending on day of data collection (or all patients if < 30 attend that day—For each medicine, the labelling on the container in which they were dispensed must contain name of medicine, how many times a day to take medicine, and how much to take each time. (Number of patients with all dispensed medicines labelled correctly/number of patients assessed) × 100. Medicines must each be dispensed in a separate container (pill bottle or envelope), and each container must contain at a minimum the three items of labelling assessed. These items all are important for whether the patient can take the medicine regularly as prescribed. 21
How to Investigate Adherence to Antiretroviral Treatment: An Indicator-Based Approach Record keeping 17. The percentage of facilities with a functioning clinic attendance register showing all patients who visited each day. 18. The percentage of facilities with an appointment book or other appointment system showing all patients due for clinic attendance each day. Rationale Source of data Data collection Computation Comments Without a system to know who is expected and who has already kept their appointment, it is impossible to monitor whether patients have come when they were scheduled, and therefore not possible to contact them and remind them of their missed appointment. Facility interview. While doing the facility interview ask to look at the appointment and attendance and appointment systems and check for whether it is being used successfully on the day of the interview. Clinic attendance register—The presence of a functioning clinic attendance register. Appointment book—The presence of a functioning appointment book system. It is important to check whether the system is functioning. It would help to ask who is expected at the next clinic day, who came yesterday, and how many failed to turn up yesterday? If these questions can be answered easily, the system is working. Patient care indicator determinants Information and communication 17. Patient knowledge of ARV regimen—Percentage of patients who know when to take each of their ARV medicines and how much to take each time. Rationale Source of data Data collection Computation Comments Detailed knowledge of the correct ARV regimen is essential to adherence. Patient exit interviews Based on a sample of 30 patients attending on day of data collection (or all patients if < 30 attend that day)—For each ARV in treatment regimen, ask ―Could you please tell me how many times a day you take this medicine, how much you take each time, and whether you take it before or after eating or with your meal?‖ Number of patients knowing all three aspects of all ARVs/number of patients asked) × 100 Need to determine correct treatment regimen for all ARVs used. This is asked during the exit interview leading up to the self report on missed doses over the last three days. So for each ARV in turn the interviewer asks the patient "when are you meant to take this medicine?" and then asks ‚and in the last three days have you missed any of your doses?‛ 22
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