joshua kayiwa inrud-iaa, uganda. session objectives narrate the experience of the uganda inrud-iaa...
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![Page 1: Joshua Kayiwa INRUD-IAA, Uganda. Session Objectives Narrate the experience of the Uganda INRUD-IAA team in collecting, cleaning, summarizing and analyzing](https://reader030.vdocuments.us/reader030/viewer/2022032722/56649cf55503460f949c431e/html5/thumbnails/1.jpg)
Collection and analysis of longitudinal pharmacy refill data
from manual registers: Experiences from Ugandan public
health systems
Joshua KayiwaINRUD-IAA, Uganda
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Session Objectives
Narrate the experience of the Uganda INRUD-IAA
team in collecting, cleaning, summarizing and
analyzing manually recorded pharmacy refill data
for longitudinal research
Make recommendations for similar longitudinal
studies in the African health systems context
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Brief BackgroundMost public health systems in low and middle
income countries maintain patients’ treatment data in manual registers
Mainly due to constraints in technological, financial and human resource capacity to design and maintain appropriate Electronic Medical Record Systems (EMRs)
Has implications for data security, availability, accessibility, accuracy, completeness, and the ease of using such data to study policy impacts
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Background to INRUD-IAA StudyDesigned as a longitudinal staggered entry interventional
study among six public health facilities in Uganda
Aim was to investigate the extent to which low-cost interventions meant to reduce clinic congestion, implemented at health facility level would improve patients’ individual-level adherence to antiretroviral therapy (ART) Results in press and also presented elsewhere in this ICIUM
meeting
Collected pharmacy-refill information for evaluation Appointment dates, actual visit dates, numbers of pills
dispensed 720 ART-experienced and 761 patients newly initiating ART for
six months pre-intervention and nine months post-intervention
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Where Were Raw Data Found?
• Longitudinal patient-level data in clinical records, diaries, pharmacy, appointment registers
• Manually filled and kept at facility or with patients
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What Were We Trying to Measure? Key study outcomes :
% of experienced patients with >30 days of dispensed medication
% of experienced patients missing any scheduled visit
% of experienced patients with 3 or more days without medication
Time until newly-treated patients experienced a medication gap of >7 or >14 days during first 120 days of treatment
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Challenges with Collecting Data from Manual Registers and Diaries
Data availabilityHealth workers only record what they think they need to
administer today’s treatmentData often missing, e.g., # of pills dispensed, patients’ CD4
and viral load history
Data accessibility and securityHard to access, especially for patient diariesDiaries prone to wear and tear due to mishandlingPages may tear out or be destroyed by cockroaches / mould
Data accuracy and reliabilityData not protected against entry errors Cannot be verified against secondary sources.
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Managing Longitudinal Data Collected from Manual Registers
Data collected and recorded using a standard tool by trained research assistants
Data entry and validationCustomized double entry data input and validation using MS
ExcelFurther quality checks in Stata before analysis
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Summarizing the DataUsing appointment
and visit dates and days of medication dispensed, we computed: % of patients
receiving more than 30 days of medication
Number of days by which patient missed any visit (see graph)
Gaps medication availability between appointments
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Key Findings (manuscript in press)Among experienced patients,
interventions led to Significant two-fold increase in
patients receiving >30 days of dispensed medication
Significant 33% reductions of missed appointments
Significant 31% reductions of experiencing a medication gap of 3+ days
Among newly treated patients, interventions associated with Significant 44% reduction in
hazard of experiencing medication gap of >7 days (see graph)
Significant 38% reduction medication gap of >14 days
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Aim Achieved?We aimed to
determine whether interventions to reduce clinic congestion, improve patient flow and if this would translate into better ART adherence.
Using routine data from manual clinic records, we were able to measure increases in days of medication dispensed, reductions in missed visits, and fewer medication gaps among ART patients.
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Lessons Learnt and RecommendationsIt is possible to collect pharmacy refill records from
manual registers in African health facilitiesMany challenges: especially data completeness,
accuracy, security and reliability
RecommendationsManual pharmacy registers and clinical records safer
when kept at the health facility than with patientsMore attention to staff training in record keepingUnless staff see data used for clinical care, management,
or research, they have no incentive to record accuratelyPharmacy refill records should ideally be kept
electronically, whenever resources (human and financial) allow
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Thanks Very Much