At AMPATH, for EMR sites, we rely on the generation of patient lists by the EMR to identify patients who are missing and needed follow-up. The AMPATH team creates custom queries to “find” the right patients who meet the criteria for missing: 1) alive; 2) missed their most recent appointment; 3) not transferred out. In addition, because many patients will return to clinic within 1 week of a missed appointment without intervention, we don’t necessarily follow up patients immediately (this is dependent on each clinic to make this assessment).
We have frequent challenges with creating these lists. For starters, as mentioned in the other thread (What are some appointment management tracking challenges?), appointment management itself is very tricky. As a result of not necessarily tracking if/when patients came to clinic, it is difficult to accurately generate the list of who is missing.
Another challenge for creating these lists is that sometimes, patients are told at the pharmacy to come back at different times than as recorded by clinician (perhaps due to drug supply issues). This creates a divergence in the data that results in incorrectly identifying someone as not needing follow up when they might.
We would be very interested in working with other organizations on an EMR module to digest appointment based and convert to trustworthy lists that our organization can use for both identifying who should be followed up as well as for reporting purposes.
I would like to know from the other members what has been happening during the last 6 months with the new pandemic situation across the world, how have the appointments been managed? For example in Moz home visit have been discontinued during this time, the Mozambican MoH is been supporting the multi month dispensary of the drugs, but I would like to hear from other countries what is happening.
In Haiti, we have seen that multi-month dispensing has increased dramatically following “arrival” of COVID in Haiti in mid-March. There are now about 60% of patients getting ART prescriptions for about 6 months and about 85% who are getting ART prescriptions for >3 months. I wonder about the role of “telemedicine” type approaches to engage with patients in the context of these long intervals between formally engaging with the health system.
Distance to the health centers as well inaccessibility of good roads especially at the rural environments in most part of Nigeria are major challenges facing clients and as a result they tend to miss their appointment.
A very good current practice is the utilization and empowerment of PMVs by some of the HIV partners in Nigeria. These PMVs are supplied with sufficient ARVs and since they are located within the community of the clients, they professionally help to dispense the drugs to the clients at an agreed location thereby upholding the privacy of the client.
Also, during this pandemic, a lot of clients were placed on ART prescriptions of 6 months and an assigned Case Manager is tasked with the responsibility of follow up calls to ensure strict adherence.
@jeshiver -About current practices in identifying missed appointments in my organization uses Point of care (EMR) that is built on OpenMRS .
1.We have an appointment diary across all calendar days/months as per the client bookings. When a client misses an appointment it means they will not be captured to have had a visit that day and therefore the records for that day will remain untouched. That way we are able to see who did not appear for the entire day and be able to initiate follow up by clicking on the number that missed which gives the entire patient lists and that way we are able to get to the individual patient charts, using the phone numbers provided by the same patients in our records we initiate phone follow up or home visits using the physical locator information including maps to the individual place of residence or place of work.
2. The specific data captured on electronic system is the patient lists containing the identifiers,name,Date of missed appointment age ,sex,telephone numbers among other parameters across all EMR supported clinics.
