Health at Home – The AMPATH Evolution
Sonak Pastakia, PharmD, MPH, BCPS Assistant Professor
Purdue University College of PharmacyCollaborator, Chronic Disease Management Program
Objectives
Provide a brief overview of AMPATH Discuss AMPATH’s transition Describe the structure and design of
comprehensive care in Western Kenya Analyze key early results from the
diabetes care program Describe areas of care focused research
Academic Model for Prevention And
Treatment of HIV/AIDS
Academic Model Providing Access To
Healthcare
Development of the Program
Initiated in November 2001 55 care sites in western Kenya
Catchment population ~ 2.2 million HIV prevalence 2 – 30% >130,000 patients enrolled; 75,000 active patients with 40,000 on cART
Academic Model Providing AccessTo Healthcare
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Cumulative Patients Enrolled: Nov ’01 – Mar ’08
80% of Chronic Disease Deaths Occur in Low & Middle Income Countries
Home Based Screening
Village based screening at innovation sites
Targeted Diagnostic Testing
Referral to clinic for enhanced careLinked to care by community worker
Perpetual door to door screening for chronic diseases
Community Screening
AMPATH Approach to Screening
Health at Home
Adults Children Total Pregnant Women
Number Tested 317,172 38,376 355,548 8,977
Number and Percent Positive
9,731 (3.1%)
702 (1.8%) 10,433 (2.9%)
396 (4.4%)
Number Newly Identified HIV positive
8039 (83%) 1028 (83.3%)
8641 (83%)
310(78%)
Number of Orphaned and Vulnerable Dependents Identified
36,593 51,066 87,659
Preliminary Screening Data from Webuye
ParameterParameter ResultResultNumber Screened 350Number with random blood sugar > 7.0 mmol/L (128 mg/dL)
47
Total number returning for a confirmatory testing/diagnosis at the health center
19
Total number confirmed with diabetes 4Estimated prevalence of diabetes 1.1**60% of patients did not return for follow-up
MTRH Center
of Excellence
Port Victoria Mosoriot
Turbo
Chulaimbo
Teso
Primary Health Care and Chronic Disease Innovation Sites
Webuye
CHRONIC DISEASE MANAGEMENT
CASE FINDING (EARLY DIAGNOSIS) & LINKAGE TO CARE:
PHCT: HIV, BP & RBS
CASE FINDING (EARLY DIAGNOSIS) & LINKAGE TO CARE:
PHCT: HIV, BP & RBS
PATIENT CARE AND REFERRAL SYSTEM PATIENT CARE AND REFERRAL SYSTEM
AMPATH-MTRH Centers of Excellence AMPATH-MTRH Centers of Excellence
CVPD Onc DM Psych Others
HEALTH CENTER/AMPATH CHRONIC DISEASE CLINIC
Patient received and initiated to care using CDM protocols
HEALTH CENTER/AMPATH CHRONIC DISEASE CLINIC
Patient received and initiated to care using CDM protocols
DISPENSARY (RN): Triage, prevention, monitoring (BP and RBS rechecks; foot exam etc.) and dispensing role through decision support
COMMUNITY CARE AND SELF MANAGEMENT: CHEWS, CHWS, AND COUNSELORS Decision support/training on referral protocols
DISPENSARY (RN): Triage, prevention, monitoring (BP and RBS rechecks; foot exam etc.) and dispensing role through decision support
COMMUNITY CARE AND SELF MANAGEMENT: CHEWS, CHWS, AND COUNSELORS Decision support/training on referral protocols
REGIONAL/DISTRICT REFERRAL CENTERS
Patient can be admitted or treated and referred down for follow up at lower levels
Patient referred up based on defined thresholds
Patient sent home for dispensary/community/self care
Patient referred to dispensary
C. CHW performs basic assessment based on decision
support in the phone based EMR
A. Community health workers (CHWs) make home visits or client visits local dispensary
Web –based Network ServerEventually connectivity to all areas within our
catchment areaB. CHW Scans Patients Medical
ID card
D. Data entered directly into the
phone
E. Data from previous visits available for decision support
Preliminary Descriptive Data from the Clinics
Number of Active Patients at Each SiteSite Number of
Active PatientsEldoret – Moi Teaching and Referral Hospital
On insulin
On oral agents or diet control
1343
604 (45%)
739(55%)
Kitale – Kitale District Hospital
On insulin
On oral agents or diet control
1122
359 (32%)
763(68%)Webuye – Webuye District Hospital
On insulin
On oral agents or diet control
383
76(20%)
307 (80%)
Demographic Data (N=1348)
Characteristic Average or Frequency
Range
Age 52 1-92
% With Food Insecurity 35%
% With Outpatient Health Insurance
<1%
% With History of Smoking 2%
% With a History of Alcohol Use 7%
% With Caretaker Assistance 68%
5.60% 3.00%
11.50%
8.20%
5.80%64.30%
no exercise
1 time/week
2 times/week
3 times/week
4 times/week
>5 times/week
Frequency of Exercise Per Week (N=637)
1.10%
9.58%
30.61%
31.24%
20.41%
4.71% 2.35%<16
16 - 19
20-24
25-29
30-34
35-39
>40
BMI of the Diabetes Population (N=637)BMI
Home Glucose Monitoring Program Results
Patients with at least 3 months of follow up HbA1c data
101
Active patients 135
Mean HbA1c at enrolment 13.2 13.2 95%CI (12.8-13.6)95%CI (12.8-13.6)
Mean HbA1c after at least 3 months 10.2 10.2 95%CI (9.7-10.9)*95%CI (9.7-10.9)*
Mean HbA1c after at least 6 months 9.8 9.8 95% CI (9.2-10.5)*95% CI (9.2-10.5)*
% of patients with an improvement in HbA1c after at least 3 months 95%95%
*P<0.01 via t-test comparison with Mean HbA1c at enrollment
Preliminary Results from Home Glucose Monitoring
Preliminary Results from Home Glucometer Pilot-Webuye
14
13
12
11
10
9
8
7
6
5
Months of enrollment
0 3 6 9 12 15 18 21
Future Steps
• Innovative Partnerships• Price Reductions on Supplies• Development of Sustainable Models of Care• Incorporation of co-pays • Greater dependency on patients• Integrated Partnership with Kenyan
Government/ Ministry of Health