Background At “Centre de Santé de Cerca-La-Source”, a health clinic in rural Haiti, it was remarked that despite best efforts a number of patients with low CD4 counts and on ART have not been given access to cotrimoxazole prophylaxis. This in turn leads to increased vulnerability to opportunistic infections potentially raising the morbidity and mortality rates in the area.
Methods The tools and methodology of Quality Improvement in HIV care were used to quantify the problem. A prospective interventional study was put in place for a 6 month period: Apr-Sept 2012. During the 3 semesters prior, the percentage of patients receiving the prophylaxis was: 47%, 46%, 46% (Oct 2010–Mar 2011, Apr 2011–Sept 2011, and Oct 2011-Mar 2012 respectively). This project aimed to reach 90%. The assigned team through brainstorming techniques and a modified Ishikawa diagram identified causes and two main interventions dubbed: validation and synchronisation.
Results Measurement was taken after full synchronisation between EMR (Electronic Medical Record) with the pharmacy data and patient hardcopy files, all done after each intervention within a period of two weeks past each. From the 1st intervention: an increase of 14.84% of the indicator and after the second increase of 19%, leading finally to 83.23%. Final evaluation of the indicator at the end of the period after continued application of the interventions showed 93.55%, a little over the targeted 90% objective.
Conclusion This lead to greater care in verification of data integrity within our system. Patient care is automatically improved once there is betterment of a system in place to monitor what has been done and what needs to be done. Furthermore, prophylaxis reduces the mortality rate and the probability of ailments that will require hospitalisation of the patients. In a resource limited system, the discordance between EMR and reality can be quite enormous.
- quality improvement
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