Center for Pharmaceutical Management, Management Sciences for Health, Arlington Virginia, USA.
BMC Health Serv Res. 2010 Feb 19;10:43. doi: 10.1186/1472-6963-10-43.
BACKGROUND: An East African survey showed that among the few health facilities that measured adherence to antiretroviral therapy, practices and definitions varied widely. We evaluated the feasibility of collecting routine data to standardize adherence measurement using a draft set of indicators. METHODS: Targeting 20 facilities each in Ethiopia, Kenya, Rwanda, and Uganda, in each facility we interviewed up to 30 patients, examined 100 patient records, and interviewed staff. RESULTS: In 78 facilities, we interviewed a total of 1,631 patients and reviewed 8,282 records. Difficulties in retrieving records prevented data collection in two facilities. Overall, 94.2% of patients reported perfect adherence; dispensed medicine covered 91.1% of days in a six month retrospective period; 13.7% of patients had a gap of more than 30 days in their dispensed medication; 75.8% of patients attended clinic on or before the date of their next appointment; and 87.1% of patients attended within 3 days.In each of the four countries, the facility-specific median indicators ranged from: 97%-100% for perfect self-reported adherence, 90%-95% of days covered by dispensed medicines, 2%-19% of patients with treatment gaps of 30 days or more, and 72%-91% of appointments attended on time. Individual facilities varied considerably.The percentages of days covered by dispensed medicine, patients with more than 95% of days covered, and patients with a gap of 30 days or more were all significantly correlated with the percentages of patients who attended their appointments on time, within 3 days, or within 30 days of their appointment. Self reported recent adherence in exit interviews was significantly correlated only with the percentage of patients who attended within 3 days of their appointment. CONCLUSIONS: Field tests showed that data to measure adherence can be collected systematically from health facilities in resource-poor settings. The clinical validity of these indicators is assessed in a companion article. Most patients and facilities showed high levels of adherence; however, poor levels of performance in some facilities provide a target for quality improvement efforts.
背景：东非的一项调查显示，在为数不多的对艾滋病抗病毒疗法依从性进行测量的卫生机构中，实践和定义差异很大。我们评估了使用一套指标草案收集常规数据以标准化依从性测量的可行性。
方法：在埃塞俄比亚、肯尼亚、卢旺达和乌干达，每个国家各有 20 个目标设施，我们在每个设施中访谈了最多 30 名患者，检查了 100 份患者记录，并访谈了工作人员。
结果：在 78 个设施中，我们共访谈了 1631 名患者，查阅了 8282 份记录。由于难以检索记录，有两个设施无法进行数据收集。总体而言，94.2%的患者报告完全依从；在六个月的回顾期内，配给的药物覆盖了 91.1%的天数；13.7%的患者配给药物中断超过 30 天；75.8%的患者在预约日期或之前就诊；87.1%的患者在预约后 3 天内就诊。在这四个国家中的每一个国家，特定于设施的中位数指标范围为：完美的自我报告依从性为 97%-100%、配给药物覆盖的天数为 90%-95%、30 天或以上药物中断的患者为 2%-19%、按时就诊的预约为 72%-91%。个别设施差异很大。配给药物覆盖的天数百分比、覆盖天数超过 95%的患者百分比和 30 天或以上药物中断的患者百分比与按时就诊、在预约后 3 天内就诊或在预约后 30 天内就诊的患者百分比均显著相关。出口访谈中最近的自我报告依从性仅与在预约后 3 天内就诊的患者百分比显著相关。
结论：现场测试表明，可以从资源匮乏环境中的卫生机构系统地收集测量依从性的数据。这些指标的临床有效性在一篇相关文章中进行了评估。大多数患者和设施显示出较高的依从性水平；然而，一些设施的表现不佳为质量改进工作提供了目标。
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