International Union against Tuberculosis and Lung Disease, Paris, France.
BMC Health Serv Res. 2012 Jul 20;12:210. doi: 10.1186/1472-6963-12-210.
Routine monitoring of patients on antiretroviral therapy (ART) is crucial for measuring program success and accurate drug forecasting. However, compiling data from patient registers to measure retention in ART is labour-intensive. To address this challenge, we conducted a pilot study in Malawi to assess whether patient ART retention could be determined using pharmacy records as compared to estimates of retention based on standardized paper- or electronic based cohort reports.
Twelve ART facilities were included in the study: six used paper-based registers and six used electronic data systems. One ART facility implemented an electronic data system in quarter three and was included as a paper-based system facility in quarter two only. Routine patient retention cohort reports, paper or electronic, were collected from facilities for both quarter two [April-June] and quarter three [July-September], 2010. Pharmacy stock data were also collected from the 12 ART facilities over the same period. Numbers of ART continuation bottles recorded on pharmacy stock cards at the beginning and end of each quarter were documented. These pharmacy data were used to calculate the total bottles dispensed to patients in each quarter with intent to estimate the number of patients retained on ART. Information for time required to determine ART retention was gathered through interviews with clinicians tasked with compiling the data.
Among ART clinics with paper-based systems, three of six facilities in quarter two and four of five facilities in quarter three had similar numbers of patients retained on ART comparing cohort reports to pharmacy stock records. In ART clinics with electronic systems, five of six facilities in quarter two and five of seven facilities in quarter three had similar numbers of patients retained on ART when comparing retention numbers from electronically generated cohort reports to pharmacy stock records. Among paper-based facilities, an average of 13 4 hours was needed to calculate patient retention for cohort reporting using patient registers as compared to 2.25 hours using pharmacy stock cards.
The numbers of patients retained on ART as estimated using pharmacy stock records were largely similar to estimates based on either paper registers or electronic data system. Furthermore, less time and staff effort was needed to estimate ART patient retention using pharmacy stock records versus paper-based registers. Reinforcing ARV stock management may improve the precision of estimates.
对接受抗逆转录病毒疗法（ART）的患者进行常规监测对于衡量项目成功和准确预测药物至关重要。然而，从患者登记处汇编数据来衡量 ART 的保留率是劳动密集型的。为了解决这一挑战，我们在马拉维进行了一项试点研究，以评估使用药房记录来确定患者的 ART 保留率是否可以与基于标准化纸质或电子队列报告的保留率估计值进行比较。
该研究纳入了 12 家 ART 机构：6 家使用纸质登记册，6 家使用电子数据系统。一家 ART 机构在第三季度实施了电子数据系统，并仅在第二季度被列为纸质系统机构。第二季度（4 月至 6 月）和第三季度（7 月至 9 月）从各机构收集了常规患者保留队列报告，纸质或电子形式。同期还从 12 家 ART 机构收集了药房库存数据。记录每个季度开始和结束时药房库存卡上记录的 ART 续瓶数量。这些药房数据用于计算每个季度向患者发放的总瓶数，以估计接受 ART 治疗的患者人数。通过采访负责汇编数据的临床医生，收集了确定 ART 保留所需的时间信息。
在使用纸质系统的 ART 诊所中，第二季度有 6 家机构中的 3 家和第三季度有 5 家机构中的 4 家，比较队列报告和药房库存记录，报告的 ART 保留患者数量相似。在使用电子系统的 ART 诊所中，第二季度有 6 家机构中的 5 家和第三季度有 7 家机构中的 5 家，将从电子生成的队列报告中获得的保留数量与药房库存记录进行比较，报告的 ART 保留患者数量相似。在纸质机构中，使用患者登记簿计算队列报告的患者保留率平均需要 13.4 小时，而使用药房库存卡则需要 2.25 小时。
使用药房库存记录估计的 ART 保留患者数量与基于纸质登记簿或电子数据系统的估计值基本相似。此外，使用药房库存记录估计 ART 患者保留率所需的时间和工作人员工作量明显少于使用纸质登记簿。加强 ARV 库存管理可能会提高估计的准确性。
