scholarly journals Retention of HIV-Positive Adolescents in Care: A Quality Improvement Intervention in Mid-Western Uganda

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Jonathan Izudi ◽  
John Mugenyi ◽  
Mary Mugabekazi ◽  
Benjamin Muwanika ◽  
Victor Tumukunde Spector ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Improvement Intervention ◽  
Hiv Positive ◽  
Mobile Phone Technology ◽  
Fishbone Diagram ◽  
Context Specific ◽  
Western Uganda ◽  
Hiv Programs ◽  
Improvement Intervention

Background. Low retention of HIV-positive adolescents in care is a major problem across HIV programs. Approximately 70% of adolescents were nonretained in care at Katooke Health Center, Mid-Western Uganda. Consequently, a quality improvement (QI) project was started to increase retention from 29.3% in May 2016 to 90% in May 2017. Methods. In May 2016, we analyzed data for retention, prioritized gaps with theme-matrix selection, analyzed root causes with fishbone diagram, developed site-specific improvement changes and prioritized with countermeasures matrix, and implemented improvement changes with Plan-Do-Study-Act (PDSA). Identified root causes were missing follow-up strategy, stigma and discrimination, difficult health facility access, and missing scheduled appointments. Interventions tested included generating list of adolescents who missed scheduled appointments, use of mobile phone technology, and linkage of adolescents to nearest health facilities (PDSA 1), Adolescent Only Clinic (PDSA 2), and monthly meetings to address care and treatment challenges (PDSA 3). Results. Retention increased from 17 (29.3%) in May 2016 to 60 (96.7%) in August 2016 and was maintained above 90% until May 2017 (with exception of February and May 2017 recording 100% retention levels). Conclusion. Context specific, integrated, adolescent-centered interventions implemented using QI significantly improved retention in Mid-Western Uganda.

scholarly journals Evaluating context-specific evidence-based quality improvement intervention on lymphatic filariasis mass drug administration in Northern Ghana using the RE-AIM framework

2021 ◽  
Vol 49 (1) ◽  
Author(s):  
Alfred Kwesi Manyeh ◽  
Tobias Chirwa ◽  
Rohit Ramaswamy ◽  
Frank Baiden ◽  
Latifat Ibisomi
Keyword(s):  
Quality Improvement ◽  
Needs Assessment ◽  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Northern Ghana ◽  
Quality Improvement Intervention ◽  
Evidence Based ◽  
Context Specific ◽  
Improvement Intervention

Abstract Background Over a decade of implementing a global strategy to eliminate lymphatic filariasis in Ghana through mass drug administration, the disease is still being transmitted in 11 districts out of an initial 98 endemic districts identified in 2000. A context-specific evidence-based quality improvement intervention was implemented in the Bole District of Northern Ghana after an initial needs assessment to improve the lymphatic filariasis mass drug administration towards eliminating the disease. Therefore, this study aimed to evaluate the process and impact of the lymphatic filariasis context-specific evidence-based quality improvement intervention in the Bole District of Northern Ghana. Method A cross-sectional mixed methods study using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate the context-specific evidence-based quality improvement intervention was employed. Quantitative secondary data was extracted from the neglected tropical diseases database. A community survey was conducted with 446 randomly selected participants. Qualitative data were collected from 42 purposively selected health workers, chiefs/opinion leaders and community drug distributors in the study area. Results The evaluation findings showed an improvement in social mobilisation and sensitisation, knowledge about lymphatic filariasis and mass drug administration process, willingness to ingest the medication and adherence to the direct observation treatment strategy. We observed an increase in coverage ranging from 0.1 to 12.3% after implementing the intervention at the sub-district level and reducing self-reported adverse drug reaction. The level of reach, effectiveness and adoption at the district, sub-district and individual participants’ level suggest that the context-specific evidence-based quality improvement intervention is feasible to implement in lymphatic filariasis hotspot districts based on initial context-specific needs assessment. Conclusion The study provided the groundwork for future application of the RE-AIM framework to evaluate the implementation of context-specific evidence-based quality improvement intervention to improve lymphatic filariasis mass drug administration towards eliminating the disease as a public health problem.

scholarly journals Evaluating Context-Specific Evidence-Based Quality Improvement Intervention on Lymphatic Filariasis Mass Drug Administration in Northern Ghana Using the RE-AIM Framework.

2020 ◽  
Author(s):  
Alfred Kwesi Manyeh ◽  
Tobias Chirwa ◽  
Rohit Ramaswamy ◽  
Frank Baiden ◽  
Latifat Ibisomi
Keyword(s):  
Quality Improvement ◽  
Needs Assessment ◽  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Northern Ghana ◽  
Quality Improvement Intervention ◽  
Evidence Based ◽  
Context Specific ◽  
Improvement Intervention

Abstract BackgroundOver a decade of implementing a global strategy to eliminate lymphatic filariasis in Ghana through mass drug administration, the disease is still being transmitted in 22 districts out of an initial 98 endemic districts identified in 2000. A context-specific evidence-based quality improvement intervention was implemented in the Bole District of Northern Ghana after an initial needs assessment. This study aimed to evaluate the process and impact of the intervention on implementation of lymphatic filariasis mass drug administration in Bole District of Northern Ghana. MethodThe study used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework based on a mixed-methods approach to evaluate the context-specific evidence-based quality improvement intervention. Results The findings of the evaluation showed that there was an improvement in social mobilization and sensitization, knowledge about lymphatic filariasis and mass drug administration process, willingness to ingest the medication, and adherence to the directly observe treatment strategy. We observed a 6.3% increase in the district mass drug administration coverage and reduction in self-reported adverse drug reaction. The level of reach, effectiveness and adoption as the district, sub-district and at the individual participants’ level suggest that the context-specific evidence-based quality improvement intervention is feasible to implement in LF hotspot districts based on initial context-specific needs assessment. ConclusionThe study provided the groundwork for future application of the RE-AIM framework to evaluate the implementation of context-specific evidence-based quality improvement intervention to improve mass drug administration towards the elimination of lymphatic filariasis as a public health problem.

scholarly journals Evaluating context-specific evidence-based quality improvement intervention on lymphatic filariasis mass drug administration in Northern Ghana using the RE-AIM framework

2020 ◽  
Author(s):  
Alfred Manyeh ◽  
Tobias Tobias ◽  
Rohit Ramaswamy ◽  
Frank Baiden ◽  
Latifat Ibisomi
Keyword(s):  
Quality Improvement ◽  
Needs Assessment ◽  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Northern Ghana ◽  
Quality Improvement Intervention ◽  
Evidence Based ◽  
Context Specific ◽  
Improvement Intervention

Abstract BackgroundOver a decade of implementing a global strategy to eliminate lymphatic filariasis in Ghana through mass drug administration, the disease is still being transmitted in 22 districts out of an initial 98 endemic districts identified in 2000. A context-specific evidence-based quality improvement intervention was implemented in the Bole District of Northern Ghana after an initial needs assessment. This study aimed to evaluate the process and impact of the intervention on implementation of lymphatic filariasis mass drug administration in Bole District of Northern Ghana. MethodThe study used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework based on a mixed-methods approach to evaluate the context-specific evidence-based quality improvement intervention. Results The findings of the evaluation showed that there was an improvement in social mobilization and sensitization, knowledge about LF and MDA process, willingness to ingest the medication, and adherence to the DOT Strategy. We observed a 6.3% increase in the district MDA coverage and reduction in self-reported adverse drug reaction. The level of reach, effectiveness and adoption as the district, sub-district and at the individual participants’ level suggest that the CEQI intervention is feasible to implement in LF hotspot districts based on initial context-specific needs assessment. ConclusionThe study provided the groundwork for future application of the RE-AIM framework to evaluate the implementation of context-specific evidence-based quality improvement intervention to improve LF MDAs towards the elimination of LF as a public health problem.

scholarly journals Improving Documentation of Distress in Veteran Patients for Hematology/Oncology Clinics

2019 ◽  
Vol 15 (5) ◽  
pp. e475-e479
Author(s):  
Samantha Bodner ◽  
Arpan Patel ◽  
Priya K. Gopalan
Keyword(s):  
Quality Improvement ◽  
Medical Records ◽  
Medical Center ◽  
Quality Improvement Intervention ◽  
Pdsa Cycle ◽  
Patients Experience ◽  
Cancer Network ◽  
Improvement Intervention

The purpose of this quality improvement study was to improve physician documentation of distress in medical records of hematology/oncology veteran patients at the Malcolm Randall Veteran Affairs (VA) Medical Center hematology/oncology fellows’ clinic in Gainesville, Florida. Before this intervention, the VA hematology/oncology fellows were not documenting patient distress in medical records. The quality improvement intervention was executed through the use of Plan-Do-Study-Act (PDSA) cycles with an ultimate goal of 50% documentation rate. Physician charts were audited to investigate official documentation of distress in patient charts. Physician documentation of distress was 14% in the first PDSA cycle, 21% in the second PDSA cycle, and 36% in the third PDSA cycle. Additional data on distress in hematology/oncology veteran patients were collected using the National Comprehensive Cancer Network Distress Thermometer and Problem List for Patients. Analysis of findings indicated that 42% of 88 patients experienced distress. Findings also suggest that hematology/oncology veteran patients experience specific sources of distress, notably fatigue and pain. These patients have presumably undergone unique experiences that can result in distress that providers should follow-up with in medical charts. Although this intervention has proven challenging to fully implement, standardizing patient distress in patient medical records has the potential to improve the quality of care provided by hematology/oncology physicians.

scholarly journals Evaluating Context-Specific Evidence-Based Quality Improvement Intervention on Lymphatic Filariasis Mass Drug Administration in Northern Ghana using the RE-AIM Framework.

2020 ◽  
Author(s):  
Alfred Kwesi Manyeh ◽  
Tobias Chirwa ◽  
Rohit Ramaswamy ◽  
Frank Baiden ◽  
Latifat Ibisomi
Keyword(s):  
Quality Improvement ◽  
Needs Assessment ◽  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Northern Ghana ◽  
Quality Improvement Intervention ◽  
Evidence Based ◽  
Context Specific ◽  
Improvement Intervention

Abstract BackgroundOver a decade of implementing a global strategy to eliminate lymphatic filariasis in Ghana through mass drug administration, the disease is still being transmitted in 22 districts out of an initial 98 endemic districts identified in 2000. A context-specific evidence-based quality improvement intervention was implemented in the Bole District of Northern Ghana after an initial needs assessment. This study aimed to evaluate the process and impact of the intervention on implementation of lymphatic filariasis mass drug administration in Bole District of Northern Ghana. MethodThe study used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework based on a mixed-methods approach to evaluate the context-specific evidence-based quality improvement intervention. Results The findings of the evaluation showed that there was an improvement in social mobilization and sensitization, knowledge about lymphatic filariasis and mass drug administration process, willingness to ingest the medication, and adherence to the directly observe treatment strategy. We observed a 6.3% increase in the district mass drug administration coverage and reduction in self-reported adverse drug reaction. The level of reach, effectiveness and adoption as the district, sub-district and at the individual participants’ level suggest that the context-specific evidence-based quality improvement intervention is feasible to implement in LF hotspot districts based on initial context-specific needs assessment. ConclusionThe study provided the groundwork for future application of the RE-AIM framework to evaluate the implementation of context-specific evidence-based quality improvement intervention to improve mass drug administration towards the elimination of lymphatic filariasis as a public health problem.

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