Improving care for patients on antiretroviral therapy through a gap analysis framework

Massoud, M Rashad; Shakir, F; Livesley, Nigel; Muhire, Martin; Nabwire, Juliana; Ottosson, Amanda; Jean-Baptiste, Rachel; Megere, Humphrey; Karamagi-Nkolo, Esther; Gaudreault, Suzanne; Marks, Pamela; Jennings, Larissa

doi:10.1097/qad.0000000000000742

Cited by 7 publications

(4 citation statements)

References 10 publications

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“…We grouped approaches into 4 main categories with support from experts in the Quality of HIV Care Technical Working Group (Fig. 1): health systems approaches using QI methods (n = 20), 21,22,24–26,29–43 standard-based methods that use QI tools to improve performance gaps (n = 2), 17,23 campaigns that use QI methods (n = 1), 28 and QI learning networks including collaboratives (n = 6). 15,16,18–20,27 Initiatives were performed in 13 LMICs, including South Africa, 15,19,20,28 Vietnam, 16,35 Zambia, 17,23 Nigeria, 18,27 Uganda, 21,22,31,36,40 Mozambique, 21,22 Namibia, 21,22,29,34,42,43 Haiti, 21,22,24,32,36,41 Thailand, 25,26 Nicaragua, 33 Kenya, 38 Tanzania, 37 and Guyana, 34,39 (Fig.…”

Section: Resultsmentioning

confidence: 99%

Do Quality Improvement Initiatives Improve Outcomes for Patients in Antiretroviral Programs in Low- and Middle-Income Countries? A Systematic Review

Hargreaves

Rustage

Nellums

et al. 2019

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Section: Resultsmentioning

confidence: 99%

Do Quality Improvement Initiatives Improve Outcomes for Patients in Antiretroviral Programs in Low- and Middle-Income Countries? A Systematic Review

Hargreaves

Rustage

Nellums

et al. 2019

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…[ 33 ] Another traced patients lost to follow-up by conducting home visits, and for patients unable to travel to the clinic, they introduced outreach visits. [ 34 ] Roland et al, described the evaluation of multiple pilots for care of elderly patients, which offloaded work from patients through intensive team communication about patients most at risk for admission to the hospital and rapid follow-up by phone or home visits as needed for patients. [ 35 ] In many of these pilot sites, community and social services and home-care services were deployed.…”

Section: Resultsmentioning

confidence: 99%

Does the chronic care model meet the emerging needs of people living with multimorbidity? A systematic review and thematic synthesis

et al. 2018

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BackgroundThe Chronic Care Model (CCM) emerged in the 1990s as an approach to re-organize primary care and implement critical elements that enable it to proactively attend to patients with chronic conditions. The chronic care landscape has evolved further, as most patients now present with multiple chronic conditions and increasing psychosocial complexity. These patients face accumulating and overwhelming complexity resulting from the sum of uncoordinated responses to each of their problems. Minimally Disruptive Medicine (MDM) was proposed to respond to this challenge, aiming at improving outcomes that matter to patients with the smallest burden of treatment. We sought to critically appraise the extent to which MDM constructs (e.g., reducing patient work, improving patients’ capacity) have been adopted within CCM implementations.MethodsWe conducted a systematic review and qualitative thematic synthesis of reports of CCM implementations published from 2011–2016.ResultsCCM implementations were mostly aligned with the healthcare system’s goals, condition-specific, and targeted disease-specific outcomes or healthcare utilization. No CCM implementation addressed patient work. Few reduced treatment workload without adding additional tasks. Implementations supported patient capacity by offering information, but rarely offered practical resources (e.g., financial assistance, transportation), helped patients reframe their biography with chronic illness, or assisted them in engaging with a supportive social network. Few implementations aimed at improving functional status or quality of life, and only one-third of studies were targeted for patients of low socioeconomic status.ConclusionMDM provides a lens to operationalize how to care for patients with multiple chronic conditions, but its constructs remain mostly absent from how implementations of the CCM are currently reported. Improvements to the primary care of patients with multimorbidity may benefit from the application of MDM, and the current CCM implementations that do apply MDM constructs should be considered exemplars for future implementation work.

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“…The impact of the CCM on a variety of chronic diseases has been reported, including asthma, diabetes, and depression (Improving Chronic Illness Care [ICIC], 2018). Only seven studies, however, have been retrieved on the application of the CCM to HIV/AIDS (Goetz et al, 2008; Drabo et al, 2010; Tu et al, 2013; Clarke et al, 2015; Mahomed and Asmall, 2015; Massoud et al, 2015; Berenguer et al, 2018). These studies reported improved access and adherence to antiretroviral therapy, implementation of pertinent interventions, and increased involvement of PLWHA with their own care, resulting in clinical, immunological, and virological gains.…”

Section: Introductionmentioning

confidence: 99%

The Use of Assessment of Chronic Illness Care Technology to Evaluate the Institutional Capacity for HIV/AIDS Management

et al. 2019

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The effectiveness of antiretroviral therapy has rendered HIV infection a manageable chronic condition. Currently, the health systems face the challenge of adopting organizational healthcare models capable of ensuring the delivery of comprehensive care. The Chronic Care Model has been reported for its effectiveness, particularly in terms of delivery system design. In this study, the Assessment of Chronic Illness Care (ACIC) questionnaire, a soft technology widely used for other chronic conditions, was employed on a teaching hospital to evaluate healthcare provided to people living with HIV/AIDS. The ACIC technology is a self-explanatory instrument which diagnoses, among the six components of the Chronic Care Model Framework, areas for quality improvements, indicating at the same time, intervention strategies and achievements. These components are healthcare network organization, delivery system design, self-management support, decision support, clinical information systems , and community. From May to October 2014, the tool was applied to the multidisciplinary teamwork at the points of care identified, as well as to the hospital management board. Respondents broadly rated care as basic. A pronounced contrast was observed from evaluation by management board and health professional staff in some components like organization of healthcare and clinical information system. The self-management support and delivery system design were the components best evaluated by the multidisciplinary team. Combined with the array of services offered, the entry points available at the hospital can ensure healthcare comprehensiveness. However, some gaps were detected, precluding the delivery of an effective care. The ACIC was considered an adequate technology to provide knowledge of the gaps, to promote productive discussions and reflections within teams and to indicate actions to achieve improvements on healthcare for people living with HIV/AIDS.

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Improving care for patients on antiretroviral therapy through a gap analysis framework

Abstract: The ART Framework is an innovative and practical tool for HIV program managers to improve HIV care and treatment.

Cited by 7 publications

References 10 publications

Do Quality Improvement Initiatives Improve Outcomes for Patients in Antiretroviral Programs in Low- and Middle-Income Countries? A Systematic Review

Do Quality Improvement Initiatives Improve Outcomes for Patients in Antiretroviral Programs in Low- and Middle-Income Countries? A Systematic Review

Does the chronic care model meet the emerging needs of people living with multimorbidity? A systematic review and thematic synthesis

The Use of Assessment of Chronic Illness Care Technology to Evaluate the Institutional Capacity for HIV/AIDS Management

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