Assefa Yibeltal, Lynen Lut, Wouters Edwin, Rasschaert Freya, Peeters Koen, Van Damme Wim
Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
BMC Health Serv Res. 2014 Jan 29;14:45. doi: 10.1186/1472-6963-14-45.
Patient retention, defined as continuous engagement of patients in care, is one of the crucial indicators for monitoring and evaluating the performance of antiretroviral treatment (ART) programs. It has been identified that suboptimal patient retention in care is one of the challenges of ART programs in many settings. ART programs have, therefore, been striving hard to identify and implement interventions that improve their suboptimal levels of retention. The objective of this study was to develop a framework for improving patient retention in care based on interventions implemented in health facilities that have achieved higher levels of retention in care.
A mixed-methods study, based on the positive deviance approach, was conducted in Ethiopia in 2011/12. Quantitative data were collected to estimate and compare the levels of retention in care in nine health facilities. Key informant interviews and focus group discussions were conducted to identify a package of interventions implemented in the health facilities with relatively higher or improving levels of retention.
Retention in care in the Ethiopian ART program was found to be variable across health facilities. Among hospitals, the poorest performer had 0.46 (0.35, 0.60) times less retention than the reference; among health centers, the poorest performers had 0.44 (0.28, 0.70) times less retention than the reference. Health facilities with higher and improving patient retention were found to implement a comprehensive package of interventions: (1) retention promoting activities by health facilities, (2) retention promoting activities by community-based organizations, (3) coordination of these activities by case manager(s), and (4) patient information systems by data clerk(s). On the contrary, such interventions were either poorly implemented or did not exist in health facilities with lower retention in care. A framework to improve retention in care was developed based on the evidence found by applying the positive deviance approach.
A framework for improving retention in care of patients on ART was developed. We recommend that health facilities implement the framework, monitor and evaluate their levels of retention in care, and, if necessary, adapt the framework to their own contexts.
患者留存率被定义为患者持续参与治疗，是监测和评估抗逆转录病毒治疗（ART）项目绩效的关键指标之一。已确定在许多环境中，患者在治疗中的留存率欠佳是ART项目面临的挑战之一。因此，ART项目一直在努力识别并实施能够改善其欠佳留存率水平的干预措施。本研究的目的是基于在患者留存率较高的医疗机构中实施的干预措施，制定一个提高患者治疗留存率的框架。
2011/12年在埃塞俄比亚进行了一项基于积极偏差方法的混合方法研究。收集定量数据以估计和比较九个医疗机构的治疗留存率水平。进行了关键 informant 访谈和焦点小组讨论，以确定在留存率相对较高或呈上升趋势的医疗机构中实施的一系列干预措施。
发现埃塞俄比亚ART项目中各医疗机构的治疗留存率存在差异。在医院中，表现最差的机构的留存率比参照机构低0.46（0.35，0.60）倍；在健康中心中，表现最差的机构的留存率比参照机构低0.44（0.28，0.70）倍。发现患者留存率较高且呈上升趋势的医疗机构实施了一系列综合干预措施：（1）医疗机构开展的留存促进活动，（2）社区组织开展的留存促进活动，（3）个案管理员对这些活动的协调，以及（4）数据录入员建立的患者信息系统。相反，在治疗留存率较低的医疗机构中，这些干预措施要么实施不力，要么根本不存在。基于应用积极偏差方法所发现的证据，制定了一个提高治疗留存率的框架。
制定了一个提高接受ART治疗患者治疗留存率的框架。我们建议医疗机构实施该框架，监测和评估其治疗留存率水平，并在必要时根据自身情况对框架进行调整。
