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Strengthening Patient Adherence Monitoring through the Electronic Dispensing Tool (EDT)

Strengthening Patient Adherence Monitoring through the Electronic Dispensing Tool (EDT). Presenter Jennie Lates Deputy Director: Pharmaceutical Services, Ministry of Health & Social Services, Namibia.

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Strengthening Patient Adherence Monitoring through the Electronic Dispensing Tool (EDT)

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  1. Strengthening Patient Adherence Monitoring through the Electronic Dispensing Tool (EDT) Presenter Jennie Lates Deputy Director: Pharmaceutical Services, Ministry of Health & Social Services, Namibia Authors: Lates, J. (1); Sumbi, V. (2); Pereko, Dawn (2); Niaz, Qamar(1); Mabirizi, David(2) Affiliations: 1Ministry of Health and Social Services (MoHSS) Namibia, 2Strengthening Pharmaceutical Systems (SPS)

  2. Background - Namibia • Large arid country in south-western Africa; 824,295 km2 • Population ~ 2.1 million • Ministry of Health & Social Services (MoHSS) serves ~85% of populations’ health needs • Ranked as upper-middle income country but has very high level of income inequality, with Gini co-efficient 0.7

  3. Background – ART Services • Country has high HIV prevalence • Average - 13.3%; • ANC prevalence ranges from 8% - 35% • Namibia started its ART services in 2003 and had a very rapid roll out of the treatment programme. • At June 2011 over 95,000 clients receiving ART – equivalent to 71% of persons in need of ART (CD4 350 cut off) • ART services provided from 42 main ART sites and more than 136 outreach sites (clinics & health centres visited by ART team). • Namibia reported an average ARV availability of 99.9% from October 2007‐ September 2010.

  4. Background – ART Services (2) • As obstacles to access are overcome, (high availability of ARVs and services provided close to communities) attention is being increasingly focused on adherence to treatment. • Self‐reporting has, until recently, been the main measure of adherence to ART • Use of pill counts has been encouraged to assess adherence to treatment but due to severe staff shortages this has only been done at some ART sites. • Pill count results however, were entered on patient‐held records so no records of adherence kept at facilities, so it wasn’t possible for facilities to monitor patients’ adherence over time using pill counts.

  5. EDT and NDB • MoHSS, supported by USAID funded MSH/SPS, introduced an Electronic Dispensing Tool (EDT) in August 2005 • The EDT was designed to optimise ART patient management and to ensure availability of accurate data on patients on ART. • It has been rolled out to all health facilities providing ART services and a mobile EDT has been introduced for use during ART outreach sessions. • A National Data Base (NDB) has also been developed that serves as a repository for data from all ART sites, enabling easy analysis of National data from the EDT at different sites. • These tools have enabled accurate quantification of ARV needs, monitoring of Early Warning Indicators and patient mobility as well as informing decision making regarding the National Programme

  6. Intervention • MoHSS developed adherence‐monitoring module for the EDT • The adherence module is able to provide patient data for a proxy adherence measure, on‐time ARV pick up. • This is easily monitored - EDT automatically checks whether an ART patient came to collect their supply of ARVs on time • Accurate pill count data harder to obtain as requires that: • Patients on ART bring their left-over pills to their refill appointments • Pharmacy staff count and enter the number of left over pills into EDT • Therefore agreed to use appointment keeping as a proxy measure of adherence N.B. For this study “On time” was defined as within 4 days of their appointment date.

  7. Results

  8. Conclusions • With the data from the EDT adherence reports all pharmacy staff can easily identify clients who are poorly adhering to their pharmacy pick-up appointments, and provide extra counselling and support to these clients. • The reports also enable District, Regional and National level managers to track adherence in different health facilities and develop appropriate targetted interventions to address problems identified. • As a result the MoHSS should be able to optimise adherence and reduce the likelihood of resistance developing to the ARVs used in the National Programme

  9. Lessons Learnt/Implications • Data from the EDT adherence report can empower pharmacy staff to identify and address adherence concerns, without adding extra data collection and reporting burdens – which can make or break a system, in resource limited settings. • Electronic data management tools like EDT are useful for effectively monitoring individual patients’ ARV refill data as well as monitoring of the programme from Regional and National perspective • A large study of factors that affect adherence is near completion in Namibia and the results from this study will guide development of interventions to improve adherence. • The developed adherence monitoring report will be a useful tool for tracking impact of adherence interventions.

  10. Thank you

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