M Health: Tshwane COPC Experience Jannie Hugo Family Medicine
Acknowledge DOH: National, Gauteng, Tshwane FPD City of Tshwane CSIR Partners: Jacques de Vos, Japie de Jong, George Marx and teams UP Family Medicine Team
Content E-Health, M-Health and P-Health The concept of COPC in PHC today The journey of the gadget so far Fast Forward
Technology in the wrong place
Direction from DOH Quadruple burden of disease Response Re-engineering the health system to one that is based on a primary healthcare (PHC) approach, with more emphasis on promotive and preventive healthcare [...] Delivery agreement for the Health sector (2009) [Revitalizing] PHC include[s]: (i) producing a PHC-oriented service delivery model for South Africa; (ii) establishing PHC Teams in each District to improve access to health care [...] Strategic Plan 2010/11 2012/13 (2010) The model contains three streams: (a) a ward based PHC outreach team [...]; (b) strengthening school health services; and (c) district based clinical specialist teams [...] Provincial guideline (2011)
Play to score
Where is the value?
Principles of COPC Local health and institutional analysis Comprehensive Care Equity Practice with science Service integration around users
Comprehensive Care
Experience and action Tshwane: 7 sites since 2011 Registrars in community City of Tshwane: 28 teams CHW, nurse, GP 5 hours pw, medicine to home Mpumalanga mine
How WBOTs in Tshwane work 20
Local assessment Complete Health Status assessment Data available local team Business intelligence Busy with Review HSA Institutional assessment
Comprehensive Care Complete 7 modules focus on promotion and preventions Busy with Management modules for key conditions ICF (Functionality) Integrate information from community to clinic Manage referrals
Equity Identify areas of most need
Practice with Science Complete Information available real time Data analysis and research Medical students and registrars Living Laboratory Busy Data inform protocols Data at weekly meeting Learning program integrated with work program Education E,M,P CHW, nurse, GP, medical student, clinical associate, registrar, PhD
Service around users Complete ID number as identifier Arrange information around households Busy with Individual electronic records available at home and in clinic
Conclusion P-E-M-health is working in COPC Linking different systems through BUS Collaboration is key Thank you! Jannie.hugo@up.ac.za www.upfamilymedicine.co.za
Example
WBOT All households assessed
WBOT Persons with 1 TB symptom
WBOT Persons with 3 TB Symptoms
What to do? 31
TB Risk Currently pregnant And often have no food. Other dimension: drinking habits
Pregnant TB Suspect Often no Food
TB Suspect, Pregnant, No food, All 3 Alcohol
WBOT/COPC - TB TB module Have you had a cough for more than 2 weeks? Are you experiencing any sudden weight loss? Have you had night sweats for more than 2 weeks? Have you had a general loss of appetite? Have you had a fever for more than 2 weeks? TB screening answers appear verify Have you been to a clinic for these symptoms? Have you been diagnosed with TB in the past 12 months If yes... Have you been put on TB treatment If yes... For your treatment, you are taking medication completed medication stopped medication never started
WBOT/COPC - TB Definitions (1) Not suspect for TB - A person... i. without TB symptom and no diagnosis of TB in the past 12 months ii. with TB symptoms who has been to the clinic for TB testing but TB was ruled out iii. without TB symptoms who has been treated for TB and completed with past 12 months (2) TB suspects i. with TB symptoms who has not been to the clinic for TB testing ii. who has completed TB treatment in the past 12 months who still has TB symptoms (3) TB diagnosed i. with/without TB symptoms who has been diagnosed with TB and is currently on TB-Rx ii. with/without TB symptoms who has been diagnosed with TB in the past 12 months but not put on treatment iii. with or without TB symptoms who either never started the prescribed TB treatment or stopped (for whatever reason) Analysis Affected by TB (all except 1i) Controlled for TB (1ii, 1iii, 3i) Uncontrolled /Potential spreaders of TB (3ii, 3iii, 2i, 2ii)
WBOT/COPC - Tuberculosis WBOT Total Kings Kopano Masi Rona Siza Tat Th CSN Th NGO Thusa Median Total registered 56809 3710 8786 6390 7041 604 2735 8006 8905 10632 7041 Assessed 47432 2868 8198 5682 4284 506 2360 6211 7030 10293 5682 % 83.5 77.3 93.3 88.9 60.8 83.8 86.3 77.6 78.9 96.8 83.8 Not suspect 45278 2612 7797 5342 4067 453 2312 5872 6724 10099 5342 % 95.5 91.1 95.1 94.0 94.9 89.5 98.0 94.5 95.6 98.1 94.9 TB Suspects 875 50 169 117 47 47 20 181 164 80 80 % 1.8 1.7 2.1 2.1 1.1 9.3 0.8 2.9 2.3 0.8 2.1 TB Diagnosed 1279 206 232 223 170 6 28 158 142 114 158 % 2.7 7.2 2.8 3.9 4.0 1.2 1.2 2.5 2.0 1.1 2.5 Affected by TB 2866 310 523 431 273 75 87 460 430 277 304 % 6.0 10.8 6.4 7.6 6.4 14.8 3.7 7.4 6.1 2.7 5.4 Controlled for TB 1393 182 253 190 173 25 47 196 183 144 154 % 48.6 58.7 48.4 44.1 63.4 33.3 54.0 42.6 42.6 52.0 50.7 Uncontrolled for TB 1473 128 270 241 100 50 40 264 247 133 150 % 51.4 41.3 51.6 55.9 36.6 66.7 46.0 57.4 57.4 48.0 49.3
TB Follow up 100% Follow-up 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% KIN KOP MAS RON SIZ TCNS Total Present Deceased Refused Moved Not present
Number of patients Number of CHW visits received 40 35 30 25 20 15 10 5 0 No visit 1 2 3-4 5-9 >10 Cannot remember Number of visits
Out of 100 people...
Out of 100 people...
Out of 400 people (or 150 households)...
Message to WBOT You found the TB affected in the community! Only a few took part in the survey... You followed up on them! You got half of the TB suspects to the clinic About a third were then diagnosed of TB Almost all were adherent to TB treatment Household screening can be improved
WBOT/COPC Summary WBOT/COPC is possible and developing Information and information management is crucial to practice information guided COPC M-Health is central Requirements for the information management are not yet fully met WBOTs are able to locate and follow-up on individuals ( case management ) WBOT are also able to plan tailored community based intervention based on the information available (e.g. specifically address risk groups) WBOTs can identify and locate the people who are at risk Not all of the social determinants negatively impacting on health can be tackled easily...