I see that is a theme, but I don’t know fully what it means?
Great question @paul. Defaulter identification is the process of identifying which patients who were supposed to come to clinic on a given day and did not come. This list of of patients would exclude patients who came earlier than their clinic date.
For the purposes of retention, this is the process of figuring out which patients were supposed to come to clinic, did not come and may require an intervention to ensure the patient does not become lost to followup.
Unintentional - patient wanted to return, but wasn’t able to. Forgot the appt, no transportation, did not want to go to a clinic during pandemic, etc. Would be willing to be identified.
Intentional - patient did not want to be identified as a returnee. May go to multiple facilities, give false names, etc. Does not want to be identified.
Are requirements/interventions different?
Thanks for this question. We have made changes to clarify the wording.
The interventions would be different for Unintentional vs Intentional. In our program, we have significantly reduced the number who forgot their appointments because the get an automatically sent reminder 1 week and 1 day before the clinic visit. For those who are not able to come because of unavoidable circumstances and who we have managed to contact via phone, we have made arrangements to send them their medication via courier. For those that are Intentional, it is a bit more complex depending on the reason. Ushauri and EMR has made us able to identify some who inadvertently provide information similar to that used in their primary care facility but those who fake their identity are harder to identify. The use of Biometrics would be a solution for this across facilities that implement a similar system.
To me it also refers to the process of defaulter identification. There is a process based on the manual tools in the pharmacy -each patient has an individual ARV form archived in a 'mobile folder - established by the Ministry of Health of Mozambique on a weekly basis, based on identifying patients who did not show up for their scheduled pick-up at the pharmacy. This system is very hard to implement efficiently, in the first place because it is so labour-intensive. From my experience it’s when we 1. installed iDART as the electronic ARV dispense system at the pharmacies with interoperability with OpenMRS and 2. Having queries in OpenMRS giving us the weekly lists of defaulters (for example all patients who were 2 weeks late for their scheduled ART-pick up) that defaulter tracing became more easier to manage. Most of our activities to improve early or 12-months retention have automated lists from OpenMRS as a starting point. To identify defaulters more efficiently…