Improving the patient experience in accessing chronic medicine … · Go to Insert > Header & Footer > Enter presentation name into footer field 2 Gustrouw CDC is a Comprehensive

Improving the patient experience in accessing chronic medicine by

Promoting Community Based Distribution .

© Western Cape Government 2012 |

Background: Gustrouw CDC

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Gustrouw CDC is a Comprehensive Primary Health Care Facility.

It serves a community of an estimated population of 30 000 individuals.

Our adult head count per month varies:

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

Apr May Jun Jul Aug Sep

7897

8889 8919

7791 7271

8426

Headcount:

Headcount:


Cape Town Metropole:


Gustrouw CDC

© Western Cape Government 2012 | 4 Go to Insert > Header & Footer > Enter presentation name into footer field


Service area: Demarcated by red line.


Gustrouw

CDC


PHC Service Package and Staff Ratio:

PHC

CDC

2

Admin/

Info

5

Child Health

PN=3

CDL/EC

MO=3

TB/ARV

PN=1

EN=2

PHC/HAST

FP/WHC

CNP=6 Pharmacy

5

School Health

2

Oral Health

3

Allied Health

4

Cleaning

4


Background: What we do…


Gustrouw issues on average 2000 CDU parcels per month to stable chronic patients.

We serve an uninsured population of mostly elderly and unemployed patients.

They make use of public transport or are dependant on favours or to pay someone

to collect their medication.

This leads:

to increased number of defaulters,

overcrowding in the limited space at the facility,

longer waiting times for all patients at facility.


Challenge Addressed

8

We decided to improve the patient’s experience by promoting the off site medicines

collection system.

This would lead to:

increased access to their medication.

improved adherence to their medication regimen.

reduction of congestion at the facility.

reduce waiting times.

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How to do…


Make the patients aware that they could collect their monthly CDU parcels closer

to home.

To actively identify patients living close to the available venues we have

offering this service.

To expand the service by increasing the number of venues available on each

day of the week.


Desired Measurable Result

To increase our baseline of 16% of our total CDU issues per month receiving their

parcels at local venues to 30% by 30 September 2015.

This would entail increasing of CDU parcels of 310 at the end of April to 650 CDU

parcels by the end of September 2015.



IMPLEMENTATION:(Project leaders)


We started with the project beginning of May 2015.

The Project leaders were:

Sr Salie(Operational Manager) Dr Beukman(MO) Ernst(Pharmacist)


Implementation Team:


There are about 40 staff members at facility and many more off-site…

Doctors

Pharmacy

NGO : Masincendane


Stakeholders:


Patients: Most interested

in?

•Waiting times

•Location of

Club sites –

convenient.

•Dependability-

Right meds/

All meds

What is their

biggest

concern?

•To receive all

prescribed meds

on time at site

Need to do get their

support?

•Improve Patient

experience

•Improve Patient Health

•Good communication

with patient

•Must be relevant


Stakeholders:


2.Staff:

Most interested in?

•To improve the patients

experience and quality of care

What is their biggest concern?

•Delivering effective care

•Time constraints

•Workload

• System collapse

Need to do get their support?

•Reduce workload

•Increase capacity

• Support from management


Stake Holders: Off site Venues…


Strandcare

Badisa

Barmhartigheid

Phambili

Gustrouw CHC


Stakeholders:


3.Venues:

Barmhartigheid Badisa

Most interested in?

•Serving their surrounding

communities


•That the issuing of CDU parcels will disrupt

their own clubs or damage their property

•That the use of their venues will lead to a

increased burden on their budget


Stakeholders:


Venues:

Strandcare Phambili


•Manage the service in such a way as to not damage,

disrupt the venues or add to their cost burden

• Have open communication with them. To show them

the benefit of the service


Stakeholders:


4.NGO: Masincedane:

Most interested in?

•To comply with SLA

with Dept of Health

•Contribute to

addressing the Needs

of the Community

What is their

biggest concern?

•Budget

constraints

•Support from PHC

facility


•Support and provision of

consumables/items/resources/

funding


Stakeholders:


Supplier:

UTi

Most interested in?

•Core Business is to receive

new referrals to process


•Delivering CDU parcels on

time

•That there are no

discrepancies


•Supply correctly completed

referrals

•Good communication


MISSION

We undertake to provide equitable access to quality health services in partnership with the relevant

stakeholders within a balanced and well managed health system.

1. Transport:

2. NGO capacity

3. Club site availability

4. Storage space lacking

5. Communication between

stakeholders.

6. Medication availability

1. Increase frequency of Club

days. 2. Negotiate CCW allocation. 3. Gentleman’s agreement with

custodians 4. Request keeping of temporary

container

5. Feedback sessions/meetings. 6. Adequate contingency plans

in place. CCW training

Challenge

How are we going to achieve a level of30% patients collecting their CDU parcels at off site venues by 30 Sept in the

light of the above mentioned obstacles?

Current Situation

16 % of Chronic patients receiving CDU parcels collect their medication at off site community based venues.

VISION:

Quality health for all.

Measurable Result

We want to increase the % of patients receiving their CDU parcels at these venues to 30%

Obstacles and

Root Causes

Priority Actions


Process:


• Posters were placed on the doors of

the three doctor’s consulting rooms.

• Each of the doctors received maps

of the area to help them advise the

patients to the closest venue to their

home.

• The posters were not to

conspicuous, we did not want the

whole facility to join up – for a lack

of capacity.


Procedure: Referral


Doctor evaluate Chronic patient. Booked for another doctor’s

Not stable appointment.

Patient stable.

Dr writes a CDU referral for 4 – 6 months. Patient prefers to collect at

Offer service to deliver CDU parcel at local venue. Gustrouw facility.

Patient agree

Patient referral kept at Facility.

Pharmacy dispenses Prescription.

Offer service to deliver CDU parcel at local venue.

Prepares patient – dates ,time ,address of venue.

Mark CDU referral for specific delivery venue.

Patient collects CDU parcel at local venue on next CDU date.

Used Maps to aid with

venue location.



Procedure: On Collection date:


9:15 – Community Care Worker collects and signs for CDU parcels addressed for

Venue.

9:30 – CCW’s are taken to Venues with available transport by pharmacy or

Masincendane.

10:00 – 11:00 Patients Collect and sign for CDU parcels at Venue. CCW record any

queries for follow up by pharmacy for next visit.

11:15 – CCW’s are collected at Venues and returned to Gustrouw CHC.

11:30 – Pharmacy checks returned CDU parcels and sign for receipt.


Process: Dr completes referral


• Referral addressed for specific venue.

• Patient receives medication at facility.

• Referral letter forwarded to UTi.

Phambili


• Book the patient to the closest venue to his/her home.

• Patient receives Patient card with all dates to attend venue and

also the next doctors date.

• Patient to present with card on date at venue at 10:00.

• We have two venues open each day from Monday to Friday.

• Each club can help 30 patients per day.

• A maximum of 60 per day.


Process:(Continued)


hg • Pharmacy dispenses Prescription.

• Registers Patient name/number on

Venue name list and 1st collection

date.

• Register used as reference to

ensure that all new Patients will

receive parcels.

• Lists are kept on file.


Process:(Continued)


A tick sheet is kept to

monitor new referrals to

off site venues.


Process(continued)


• Every morning each Venue’s Parcels are counted

and signed for by the responsible staff member

and Masencindane CCW.

• Afterwards the CCW returns the uncollected

parcels to the pharmacy, where the parcels are

checked and the register signed.


Process: At the Venue:


• A manifest accompanies the CDU parcels to the Venue.

• Each patient, on receipt of his/her medication must sign the manifest.

• The manifest is kept in the Venue’s folder for proof of receipt.

• A manifest accompanies the CDU parcels to the Venue.

• Each patient, on receipt of his/her medication must sign the

manifest.

• The manifest is kept in the Venue’s folder for proof of

receipt.


Operational Challenges(Enemies)

1. Patients that received wrong dates.

2. Patient allocated to wrong site.

3. Time constraints limit the amount of patients that can be referred.

4. Venue closed, no one available to open.

5. Patients do not feel safe at location.

6. CDU Parcels that didn’t arrive.

7. No available car on the day.

8. Not all medication received by patient.


Results:

% of total CDU patients that collect medication at off site Venues.


0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

April May June July Aug Sept

16.01

21.25 20.74 22.47

28.28

30.50

%

Off site collection

Off site % of total cdu


Results:


0.00

500.00

1000.00

1500.00

2000.00

2500.00

April May June July Aug Sept

1936.00 1878.00

2073.00 2185.00

2238.00 2243.00

310.00 399.00 430.00

491.00

633.00 683.00

Total no CDU issued/issued off site:

Total CDU issued:

Off site Venue


Distribution of patients across venues:


Badisa

32%

Phambili

32%

Strandcare

15%

Barmhartigheid

21%


Patient satisfaction survey:


Questions:

Yes:

1. Will you promote this service to your neighbour? 93%

2. How do you feel? Is this a good service? 100%

3. Is it better compared to receiving medication at the clinic? 86%

4. Does it save you time, fetching your medication here? 86%

5. The experience was positive and you didn’t encounter difficulties? 93%


Acknowledgements


Custodians of Venues: Ps Colin van Wyk and Ds Cloete.

Community Care Workers and co-ordinators of Masincedane: Sr Riffel, Sr

Southon, Jacky, Shereen, Leon and Mina.

Doctors and Pharmacy staff.

All the vehicles used officially and unofficially to make this project

successful.

Tiwonge, Percy, Sue and Gail from MSH

Johan and Zuki at KESS

Documents

Improving the patient experience in accessing chronic medicine … · Go to Insert > Header & Footer > Enter presentation name into footer field 2 Gustrouw CDC is a Comprehensive