Poster from the September 2012 Integration for Impact Conference.

1. Introduction
Do Integrated The Three Interlinked Patient • strengthen linkages between
Data Collection Tools Monitoring Systems for HIV
care/ART, MCH/PMTCT and
HIV and TB, malaria, MCH,
and FP/RH services; and
TB/HIV contains a standardized
Promote Integrated minimum data set and illustrative
tools and guidelines that help
• promote integrated service
delivery.
Service Delivery? countries:
• put in place national,
In 2011/12 the Ministry of Health
of Cote d’Ivoire adapted these
interlinked tools, known in Cote
A Case Study from Cote d’Ivoire facility-based, patient-level d’Ivoire as ”outil intégré du suivi
data collection and reporting du patient VIH” or IPMS, and
tools; piloted them for 3 months in
Upama Khatri, Stephanie Mullen, 3 districts.
• improve the management
Leontine Gnassou, Suzanne Cloutier,
of patients in HIV care and
Heidi Reynolds & Amanda Makulec
treatment programs;
MEASURE Evaluation
When health services become inte-
grated, the support systems, such as
Methods the health information system, must
also become integrated This case
Study Design: Retrospective case
study explores the interaction be-
study using a mixed method approach
tween two of the six health systems
(quantitative questionnaire and qualita-
building blocks - service delivery and
tive key informant interviews, KII) to ex-
the health information system.
plore if tool users perceived improve- Three Interlinked Patient Monitoring Systems for HIV
care/ART, MCH/PMTCT, and TB/HIV: Standardized Mini-
ments in patient monitoring and service mum Data Set and Illustrative Tools.
integration with the introduction of the Geneva: World Health Organization, April 2010. SERVICE DELIVERY
IPMS tools.
HEALTH INFORMATION SYSTEMS
Study Target Popuation: Tool users
from 8 IPMS pilot sites and 8 control HEALTH WORKFORCE
Map of Pilot IPMS and Control Sites
sites (n=98) that had continued using
the 2006 version of the WHO patient ACCESS TO ESSENTIAL MEDICINES
monitoring tools.
FINANCING
Survey Respondents Number
Total 98 LEADERSHIP & GOVERNANCE
Facility 64
Service providers 58 The poster specifically focuses
District 8 on two of the study’s research
National 6 questions:
• Do the IPMS tools improve
patient monitoring?
Preliminary Findings • Do the IPMS tools improve
integration of services?
In general, service providers have a positive perception of the IPMS tools with re-
spect to the usefulness of the tools in helping them make informed diagnoses;
provide appropriate follow-up care to patients; monitor patients in care and
treatment settings; monitor HIV-positive pregnant women; and monitor HIV-
exposed infants.
Do the IPMS tools improve Do the IPMS tools improve
patient monitoring? integrated services?
The quantitative analysis found that There were no significant differences
significantly more service providers using in the quantitative analysis between
the IPMS tools agree (”agree” and “partially reports of the new IPMS and old patient
agree”) that the tools are effective in help- monitoring tools with respect to the
ing them monitor six types of integrated effectiveness of the tools to 1) improve
services compared to providers using the coordination of patient care between
old patient monitoring tools, as shown in HIV and other services; 2) improve
the graph below. communication of patient information
between HIV and other services; and
3) increase client referrals between HIV
Comparison of service providers' and other services. This could have been
perceptionsof the new IPMS tools due to the short pilot period and respon-
v. old patient monitoring tools dents not being fully conversant with
100
90 85
the IPMS tools at the time of the study.
Old tools
81
80 New tools
Percent of respondents who answered
68
70
However, the qualitative analysis found
“Agree” or “Partially agree”
65
60 58
50
40 40
46 46 that service providers using the IPMS
40
30
33
28 tools found them helpful in facilitating
20
10
14 an integrated approach to care.
0
HIV+ screened HIV+ nutritional HIV+ pregnant HIV+ pregnant HIV exp. infants HIV+ women
for STI (p<.027) status assessed
(p<.002)
women provided
IPT for malaria
(p<.0012)
women use
ITNs (p<..0003)
exclusively
breastfed 6 mo.
(p<.0366)
receive FP
counseling
(p<.05)
“Delivery room, pediatrics, pharmacy and
counseling services are integrated. The “The [IPMS] tools are essential for
[IPMS] tools help everyone participate, at the care of patients on treatment
their respective levels, to care for patients.” because [they] help track the status of
- from a Service Provider KII the patient from the point of [his] initial
checkup onward...They also help with
biological and immunological monitor-
Conclusions ing which allows [service providers] to
see if there are improvements [in the
A majority of respondents believe that operating procedures that routinize status of the patient].”
the interlinked IPMS tools help integrate the operational aspects associated – from a Service Provider KII
HIV with TB, malaria, MCH, and FP/RH with rolling out new tools, including
services by helping organize patient managing the scale-up or phasing in
information related to several patholo- of the new tools and implementation
gies and services in one place, thus al- guidelines. We also recommend repeat-
lowing service providers to make in- ing the study once the IPMS tools have
formed decisions about patient care as been rolled out to more facilities and
well as program management. Although have been in use for a longer period
respondents viewed the tools positively, of time to obtain a more thorough and
several key informants mentioned, and complete understanding of the effect
we recommend, developing standard of these tools on service integration.
The results presented in the poster are preliminary and more analysis is forthcoming.
For questions or comments contact ukhatri@jsi.com