SOP: Data management in TIER.Net for patients enrolled in ... · the 1.2.2017 visit, this is verified by their initial. According to this screen shot, the data has not yet been captured

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Enquiries: please contact Dr R Govender [email protected] Version 2 date of effect: 01.02.2017

SOP: Data management in TIER.Net for patients enrolled in CCMDD Programme: Data management instructions for stable patients collecting

their ARV drugs through Central Chronic Medicines Dispensing and Distribution (CCMDD) Programme

Background of CCMDD programme

Eligible patients are registered into the Central Chronic Medicines Dispensing and Distribution (CCMDD) programme to improve access for public sector patients to chronic medication through the involvement of private sector providers (with more convenient opening hours and closer to workplace). In the era of Universal Test and Treat (UTT), the aim is to reduce workload for issuing of repeat scripts by clinicians in public health facilities and to reduce patient waiting times.

The criteria for an eligible ART patient is defined, per the Adherence Strategy and

Guidelines for HIV, TB and NCDs, as:

18 years and over

Clinically stable on ART for at least 12 months, and adherent

No opportunistic infections or adverse events

2 consecutive undetectable viral loads

No current TB and other medical condition that requires regular clinical consultation

Facilities assess stable patients and, where eligible, invite patients to enrol in the programme. Patients, who agree to join, are formally registered into the programme. A 6-month repeat prescription is written up. Patients receive their initial supply of medicines (1st repeat) from the facility and the 5 remaining repeats are dispensed by the CCMDD service provider and collected from the contracted private pick-up point or designated health care facility. The patient registration and consent forms as well as prescription are submitted to the CCMDD service provider.

Purpose of instructions

These instructions are meant to provide guidance to facilities to understand the documenting and data capture for patients on ART and enrolled in the CCMDD programme.

The capture of the patient data is the same as if they were supplied multiple months from the facility.

Overview of SOP Clinical documentation and data management actions at facility ................................................... 2

Deregistration of patients from the CCMDD programme ................................................................ 5

Listing of all patients enrolled in the CCMDD programme .............................................................. 7

Routine facility level patient management (applies to all patients in TIER.Net) ............................. 8

Facility level management of laboratory results .............................................................................. 9

Actions from private CCMDD service provider .............................................................................. 10

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Clinical documentation and data management actions at facility

Clinical Management

Record enrolment in CCMDD programme using registration form

Document in standardised clinical stationery in the notes section (e.g. figure 1)

Indicate patient issued 1/12 repeated 6 times

Record next clinical visit date in „next visit date‟ field. The next clinical visit is 6 months from the current visit.

Data capture in TIER.Net

Data capturer to receive folder

Tick the CCMDD check-box that patient has been registered in the CCMDD programme

Record in notes section in TIER.Net that the patient has been enrolled in a particular CCMDD pick-up- point, particularly when this is an external pick-up-point

Capture current visit (e.g. 1.2.2017) and 6 month repeat.

Capture next visit date (e.g. 1/8/2017)

Sign in data capture section to indicate data captured (indicated by red arrow in figure 4)

Save and close

Return folder for filing

Figure 1: Sample capture in clinical stationery, excerpt from clinical stationery column

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Figure 2: Capture in TIER.Net

Click on the CCMDD check-box. A tick will appear. This denotes that the patient is enrolled in the

CCMDD programme.

Visit on February 1, 2017 captured in TIER.Net. Under Months ART prescribed select 6 months. Tick CCMDD – Medicine collected from pick up point for non-clinical visits. Record next clinical appointment date 6 months into the future (this is 1 Aug 2017). This will indicate 6 months of ART is prescribed and the patient is not expected back into the clinic until 1 Aug 2017. Arrows in the treatment visit table denotes this. A note is documented in the notes section in TIER.Net.

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Figure 3: Treatment visit calendar with notes section

Figure 4: Recording of follow-up consultation e.g. 1.8.2017

The above is an example of clinical recording of patient at 6-month follow up consultation in August

2017. Consultation recorded, next visit date captured and folder flows to data capturer after

consultation. The red circles next to the investigations illustrate the clinician requested laboratory

tests but they have yet to be recorded into the clinical record.

Data are captured and data capturer initials bottom of clinical chart. The folder is returned for filing.

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In the image above, the blue square and arrow illustrates the data capturer captured the data from the 1.2.2017 visit, this is verified by their initial. According to this screen shot, the data has not yet been captured for the 1.8.2017 visit as no initial is in the respective column.

This also indicates the patient was seen by the Nurse R Kipling (CPN) whereas in the previous visit the patient was seen by Dr Baleni.

Deregistration of patients from the CCMDD programme

As per the National Adherence Guidelines, patients who miss their scheduled pick-up at the

CCMDD PuP and are not tracked within 30 days, will be deregistered from the programme. In

addition, women who fall pregnant while enrolled in CCMDD will also be deregistered from the

programme. These patients will return to the facility for routine management and monthly collection

of medicines.

The reason for the patient being deregistered from CCMDD must be documented in the notes

section of the patient folder by the clinician. This will then be captured by the data clerk in the notes

section of TIER.Net.

Above image of the clinical stationery illustrates the patient‟s treatment visits with two 6-monthly

visits receiving 6-month repeat prescriptions. An intervening column includes notes summarizing a

communiqué from the CCMDD service provider indicating that more than 30 days had lapsed since

the patient had collected medicines.

Tracing efforts were pursued and patient was contacted and agreed to attend the clinic. The

patient attended the clinic on the 14.11.2017 and informed they were deregistered from the

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CCMDD program. The full detail of the deregistration and engagement with patient is documented

in the clinical notes. The summary of the pertinent details are captured in the notes section in

TIER.

TIER must be amended where a patient is deregistered from the CCMDD program mid-6 month

cycle of medicine‟s collection. This ensures the patient is tracked appropriately with 1 month

medicine collection and correct “Next Appointment Date” is recorded in TIER ensuring missed

appointment reports, and other management reports, are correct.

Figure 5: The forward captured regimen must be deleted

Double click on the last month in which a visit was recorded. In this example it is August 2017.

Click Edit

Select Delete All.

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This deletes all prospectively captured visits, ending in January 2018. This deletes too many visits

and thus it is important to replace the visits with regimen collection until the missed appointment,

in this example this is October 2017. In this example you would change “Months ART Prescribed”

to 3 Month. Click Save.

The November visit is captured in TIER and the notes section is updated with the information from

the clinical notes.

Future visits will be captured as monthly visits, per normal practice. If/when a patient is re-enrolled

in the CCMDD program the SOP would be followed as from the start.

Listing of all patients enrolled in the CCMDD programme

Figure 6: Listing of patients and indication of enrolment into CCMDD

This patient listing can be used to quantify the number of patients active on ART who receive

medicines dispensed through the CCMDD programme. The column to the far right demonstrates

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the categorisations used. However, in order to produce a report, a number of steps will have to be

followed:

1. Export the patient list to Excel

a. File Export to Excel

In Excel, place your cursor in the top row and select Sort & Filter. Select Filter.

2. Under the ART Start Date column:

a. De-select (Blanks)

b. This will retain only patients with an ART start date

3. Under the Outcome column keep (Blanks) and de-select:

a. Died

b. Lost to follow-up

c. Transferred out / Moved out

d. This will provide a list of all patients still active on ART

4. Scroll to the right (probably the last column to the right) to find CCMDD at last visit?

a. De-select False

b. This will provide a list of all active patients receiving ART via CCMDD in this

reporting period.

c. Either:

i. Highlight all the remaining cells in the column to provide a sub-total of cells

containing TRUE. This will be the number of patients receiving ART through

the CCMDD at their last visit. Or,

ii. At the bottom of the column insert the following formulae:

=COUNTIF(BX2:BX5622,"TRUE"). Where BX refers to the column heading.

This will produce the number of cells containing the word TRUE and thus will

provide the total number of patients receiving ART via CCMDD in the

specific reporting period.

iii. Reminder: This is cross sectional data (point in time) and thus will only be as

complete as the data exported from TIER.Net.

Routine facility level patient management (applies to all patients in TIER.Net)

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Section 7.1.2 and Annexure B of the HIV/TB M&E SOP provide recommendations for

patient recall. Guidance is also available in the previous edition SOP, the ART M&E SOP,

on page 16.

Each Friday the early missed appointment should be pulled.

If a patient did not attend their expected appointment, per the „date of next visit’, the patient

will present on the early missed appointment list, 2 - 3 weeks after their expected visit

date. Attempts to trace patients should be made.

On the last Friday of each month the late missed appointment and the unconfirmed lost

to follow-up lists should be generated in TIER.Net. If the patient was not recalled back

into care the patients from the early missed appointment list will present on the late missed

appointment list. Attempts to trace patients should be made to recall patients back into

care.

Any patient not traced after presenting on the early and late missed appoint lists, and the

unconfirmed lost to follow-up lists will then be confirmed as lost to follow-up patients in

TIER.Net. Once confirmed LTF these patients will then be excluded from the „Total

Remaining on ART‟ and reflect as „LTF‟ in the cohort report in the respective cohort and

duration.

Facility level management of laboratory results

Laboratory results returned to facility must be reviewed by clinician before further action.

Abnormal results must be immediately followed up by a clinician

o After follow up results must be captured by the DC into TIER using the “bulk: capture

function (pending tests) [Figure 7]

The result is then filed into the patient file

Normal results must immediately be:

o Captured by the DC into TIER using the “bulk” capture function (Pending tests) [Figure

7]

o The result is then filed into the patient file

At consultation, the clinician is to record results in clinical stationery next to requested result.

Return folder for filling

Figure 7: Pending tests (bulk capture) function in TIER.Net

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Actions from private CCMDD service provider

Pick-up-point notifies CCMDD service provider if patient failed to collect package 2 days after

scheduled pick-up date.

This would trigger the patient tracing process:

o CCMDD service provider attempts to contact the patient telephonically.

o If unsuccessful, the CCMDD service provider will notify the facility of potential treatment

default.

o After 15 days the facility will use ward-based outreach teams to track patient.

o Information to be fed back to facility and actions to be captured in facility-level patient

file

CCMDD service provider to advise patient from script 4 and 5 that patient will soon need to

return to health facility for assessment and new script.

Action: if patient not traced from CCMDD service point

If patient is untraceable after 30 days and/or fails to collect package and the patient is

deregistered from the CCMDD program,

END.

Documents

SOP: Data management in TIER.Net for patients enrolled in ... · the 1.2.2017 visit, this is verified by their initial. According to this screen shot, the data has not yet been captured