At AMPATH, appointment management is not done through a dedicated appointment management system but via forms. The MOH form asks the provider to put a return date for each patient. We then have two processes for handling the future schedule. For those sites using EMR, we maintain lists of patients for each data collected via the form. In both EMR and non EMR sites, our outreach team maintains a separate manual diary for appointments. When a patient leaves the clinic, the outreach worker will record the write the persons name down on the relevant day they are to return.
This creates a few challenges for us:
The EMR does not have an easy way of updating appointments dates if a patient calls (or is called) to change the clinic date. As as result patients often appear on both the old date and new date even after a valid change.
On the manual side, it’s very tricky to make sure that all patient data is recorded. It’s easy to miss a form or a patient and not include them on the date. Additional, for a clinic with many many patients, it can be hard to find the patients in the diary and this leads to frequently failing to mark a patient has having come (making it appear like the patient missed). When patients come early or late, because it is extra work to find them, often this step is skipped and so the appointment list is no longer up to date.
In both cases, the lack of accurate appointment data leads to challenges when both figuring which patients need outreach and for reporting purposes. It is a common problem that we report a patient has LTFU even though they came to clinic simply because of missing data.
We would love to work with other organizations on the creation of an EMR module or add-on to properly support appointment scheduling and management as well as patient queueing. Something that could handle more than just a HIV related appointments would be extremely helpful. By ensuring we have accurate information on when patients did come and when they are supposed to come, we will greatly improve our processes for outreach and reporting.
Anybody who would like to share experience on advantage and disadvantgaes of using clinical visit over pill-pick ups to monitor retention in HIV care. In most settings, patients are clinically stable such that they do not need to see their clinicians after a long ques. They would rather feel comfortable picking their tablates and go home. Much easier and quicker. However, clinical record management and pharmacy systems are not linked in most settings. This situation creates information gaps on retention in care. What is the best practice short of data system integration? Thanks
This is a key topic! The situation described above from AMPATH is really familiar, from work in Haiti! An additional challenge is that there are different types of appointments in the context of differentiated care under PEPFAR, some occurring in clinical and some occurring in community settings. So it’s important to keep track of different types of appointments. This is particularly important given that we are increasingly seeing multi-month prescribing in the context of Covid. So it’s important to be able to track expected engagement in care, rather than only clinical visits.
Right now in Haiti, there is a large-scale EMR and also a digital tool for community-based defaulter tracking, but appointment reminders in the clinic are all handled via manual processes which are disconnected from the EMR. I would love to see collaborative efforts at improving appointment management within OpenMRS. I would love to see shared investment.
Hi Taffa and all,
Our donor PEPFAR uses both scheduled clinical consultations as well as scheduled ARV pick-ups to quantify patients currently on ART (TX_CURR). The Ministry of Health prioritizes ARV pick-up to consider patients retained or not and they have a point. In Mozambique, more than 90% of HF have OpenMRS and less HF - over 200 HF- have as well the point-of-care dispensation system iDART, automatically updating pick-ups in real time in OpenMRS. With our organisation Friends in Global Health, we use scheduled ARV pick-up dates of patients who recently initiated ART to establish weekly electronic lists from OpenMRS of patients who have to visit the HF in two weeks’ time. For all these patients we do a phone call attempt and if not successful (for the majority of cases), volunteers would pay them a preventative visit at home. In addition to that we would check in openMRS, patient by patient, whether the patient came back for the scheduled pick up or not. Is there any way I can attach the powerpoint and poster we presented at the AIDS2020 conference, showing improved early retention rates by intensifying these activities in 20 big volume Health Facilities of Zambezia Mozambique? I referred to this evaluation during our virtual meeting on the 13th October. Cheers!