Improving Services for HIV-Exposed Infants in Zambia and Cameroon Using a Quality Improvement Collaborative Approach

Dougherty, Gillian; Abena, Tihnje; Abesselo, Jean Pierre; Banda, Jeane Ngala; Biyaga, Tjek Paul; Boccanera, Rodrigo; Boyd, Mary Adetinuke; Ebogo, Mesmey; Hamomba, Leoda; Jed, Suzanne L.; Kakanou, Zeh Florence; Kasonde, Prisca; Kasonka, Siphiwe Chilungu; Lungwebungu, Rachael M.; Madevu-Matson, Caitlin; Mayer, Magdalene Mange; Mwamba, Mukuka; Panya, Milembe; Sakanda, Paul; Tsiouris, Fatima; Walker, Lauren; Rabkin, Miriam

doi:10.9745/ghsp-d-20-00550

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…However, we found quality improvement interventions undertaken in other health areas [ 22 , 25 , 26 ]. One sought to improve waiting time by means of hospital-wide quality improvement, using the Strengthening Laboratory Management Toward Accreditation model [ 22 ]; another sought to improve early infant diagnoses coverage, timely return of HIV test results, and initiation of antiretroviral treatment using the Quality Improvement Collaborative approach [ 25 ]; and another sought to improve the adherence and cure of patients with tuberculosis, by using SMS text message reminders [ 26 ]. We also found 2 studies [ 23 , 24 ] that aimed at investigating patients’ satisfaction with the quality of health services [ 23 ] and the undertaking of antiretroviral treatment [ 24 ].…”

Section: Introductionmentioning

confidence: 98%

Waiting Time and Patient Satisfaction in a Subspecialty Eye Hospital Using a Mobile Data Collection Kit: Pre-Post Quality Improvement Intervention

Mbwogge¹,

Astbury²,

Nkumbe³

et al. 2022

JMIRx Med

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Background Waiting time can considerably increase the cost to both the clinic and the patient and be a major predictor of the satisfaction of eye care users. Efficient management of waiting time remains as a challenge in hospitals. Waiting time management will become even more crucial in the postpandemic era. A key consideration when improving waiting time is the involvement of eye care users. This study aimed at improving patient waiting time and satisfaction through the use of Plan-Do-Study-Act (PDSA) quality improvement cycles. Objective The objectives of this study were to determine the waiting time and patient satisfaction, measure the association between waiting time and patient satisfaction, and determine the effectiveness of the PDSA model in improving waiting time and satisfaction. Methods This was a pre-post quality improvement study among patients aged 19 to 80 years, who are consulting with the Magrabi International Council of Ophthalmology Cameroon Eye Institute. We used PDSA cycles to conduct improvement audits of waiting time and satisfaction over 6 weeks. A data collection app known as Open Data Kit (Get ODK Inc) was used for real-time tracking of waiting, service, and idling times at each service point. Participants were also asked whether they were satisfied with the waiting time at the point of exit. Data from 51% (25/49) preintervention participants and 49% (24/49) postintervention participants were analyzed using Stata 14 at .05 significance level. An unpaired 2-tailed t test was used to assess the statistical significance of the observed differences in times before and after the intervention. Logistic regression was used to examine the association between satisfaction and waiting time. Results In total, 49 participants were recruited with mean age of 49 (SD 15.7) years. The preintervention mean waiting, service, and idling times were 450 (SD 96.6), 112 (SD 47), and 338 (SD 98.1) minutes, respectively. There was no significant association between patient waiting time and satisfaction (odds ratio 1, 95% CI 0.99-1; P=.37; χ23=0.4). The use of PDSA led to 15% (66 minutes/450 minutes) improvement in waiting time (t47=2; P=.05) and nonsignificant increase in patient satisfaction from 32% (8/25) to 33% (8/24; z=0.1; P=.92). Conclusions Use of PDSA led to a borderline statistically significant reduction of 66 minutes in waiting time over 6 weeks and an insignificant improvement in satisfaction, suggesting that quality improvement efforts at the clinic have to be made over a considerable period to be able to produce significant changes. The study provides a good basis for standardizing the cycle (consultation) time at the clinic. We recommend shortening the patient pathway and implementing other measures including a phasic appointment system, automated patient time monitoring, robust ticketing, patient pathway supervision, standard triaging, task shifting, physician consultation planning, patient education, and additional registration staff.

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Section: Introductionmentioning

confidence: 98%

Waiting Time and Patient Satisfaction in a Subspecialty Eye Hospital Using a Mobile Data Collection Kit: Pre-Post Quality Improvement Intervention

Mbwogge¹,

Astbury²,

Nkumbe³

et al. 2022

JMIRx Med

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“…RESPONSE: This is the first study targeting the improvement of waiting time and satisfaction in ophthalmology in Cameroon. Other quality improvement studies were found [3][4][5], including those that aimed at investigating patients' satisfaction with the quality of health care services [6] and the undertaking of antiretroviral treatment [7]. Our choice of setting has been explained and similar studies are alluded to.…”

Section: Minor Commentsmentioning

confidence: 99%

Authors’ Response to Peer Reviews of “Waiting Time and Patient Satisfaction in a Subspecialty Eye Hospital Using a Mobile Data Collection Kit: Pre-Post Quality Improvement Intervention”

Mbwogge¹,

Astbury²,

Nkumbe³

et al. 2022

JMIRx Med

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“…When attributing improvements to the QIC, this project shares several key limitations with most QI initiatives, including multiple other QICs that ICAP has supported in LMIC. [35][36][37][38][39][40] First, the fact that site-level activities and interventions were deliberately flexible, adaptable and changed over time in response to real-time data makes analysis of 'fidelity' unhelpful. Second, the absence of control or comparison sites means that external factors may have confounded our analysis.…”

Section: Lessons and Limitationsmentioning

confidence: 99%

Improving viral load utilisation to enhance care for Kenyan adolescents with HIV

Dougherty

Akoth²,

Hawken³

et al. 2022

BMJ Open Qual

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Improving the use of viral load (VL) testing for adolescents and young people living with HIV (AYPLWH) is a priority for Kenya’s Ministry of Health (MOH). Despite expansion of VL testing coverage and rollout of national policies, guidelines and training, VL result utilisation for AYPLWH remains suboptimal, with inadequate adherence to national guidelines recommending everyone on antiretroviral therapy (ART) with unsuppressed viral load (UVL) (≥401 copies/mL) receive three enhanced adherence counselling (EAC) sessions and a repeat VL test within 3 months. In March 2019, ICAP at Columbia University partnered with the MOH to launch a Quality Improvement Collaborative (QIC) at 22 health facilities in the Eastern Province to optimise management of AYPLWH on ART with UVL. Over 17 months, facility QI teams tested interventions targeting client education, workflow modifications, commodity management, community engagement and improved documentation. The QIC led to marked improvement in the proportion of clients completing three EAC sessions and repeat VL testing. Median completion rate was 16% (n=479) at baseline (from March 2018 to February 2019) and rose to 73% (n=755) during the implementation period (from March 2019 to July 2020). In the final month (July 2020), rates rose to 90% (n=31). Another success was the increase in the proportion of clients whose VL was resuppressed on repeat testing, which improved from 34% (n=273) at baseline to 62% (n=710) during the implementation period and 77% (n=44) in the final month. The QIC also led to improvement in the proportion of AYPLWH on first-line ART whose regimens were switched within 2 months of recorded UVL results, which rose from 58% (n=48) at baseline to 94% (n=128) during the implementation period. In summary, the QIC helped facility teams to identify and prioritise local, contextually appropriate innovations which led to swift improvement in three critical indicators of VL utilisation.

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Improving Services for HIV-Exposed Infants in Zambia and Cameroon Using a Quality Improvement Collaborative Approach

Cited by 6 publications

References 22 publications

Waiting Time and Patient Satisfaction in a Subspecialty Eye Hospital Using a Mobile Data Collection Kit: Pre-Post Quality Improvement Intervention

Waiting Time and Patient Satisfaction in a Subspecialty Eye Hospital Using a Mobile Data Collection Kit: Pre-Post Quality Improvement Intervention

Authors’ Response to Peer Reviews of “Waiting Time and Patient Satisfaction in a Subspecialty Eye Hospital Using a Mobile Data Collection Kit: Pre-Post Quality Improvement Intervention”

Improving viral load utilisation to enhance care for Kenyan adolescents with HIV

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