Develop a DAT intervention

Introduction

One size does not fit all! Differentiated care must be supported by evidence from validated and up-to- date data. The data should be used to monitor and track progress and improve understanding about specific patient situations as it concerns their adherence. It will help to identify strengths and key areas for improvement, and to define and implement quality-improvement activities. Importantly, in most cases the approaches do not require policy changes or significant additional resources, since they are adaptations of the current standard of care that are already implemented at the site level. Some initial investment may be necessary to support professional development and quality improvement, but the intention is not to implement new programs or processes requiring huge resources.

Goals

After reading this section, you will know:

  • How to design a differentiated care pathway to fit your country setting.

  • How to adapt the standard of care to based on data differentiation.

  • How to improve the differentiated care pathway and provide targeted support using patient dosing histories .


Differentiation of care pathway

The differentiation care pathway should be designed to match the existing standard of care with minor refinements where required. As rule of thumb the differentiation of care pathway should:

  1. Determine what actions should be carried out to support patients' return to adherence;

  2. Determine how the combination of point of time in treatment, average adherence rate, facility visits and other factors affect treatment outcomes;

  3. Determine which staff member(s) will be responsible for tracking patient adherence, the frequency of monitoring, and tracking efforts made to support patient;

  4. Support patient management and track patient accountability.

Key Interventions may include:

Patient Self-management: Support patients to take their TB medication dose as prescribed through customised SMS reminders

Dosing Clarity: Eliminate dosing confusion through the use of dosing instructions printed directly on the DAT packaging (or can printed on stickers placed directly on the packaging). Avoid printing leaflets for additional dosing instructions, as these can easily be lost or destroyed with time.

Non-adherent Trends: Review patients' dosing histories to identify non-adherent trends, for example festive periods when patient forget to take their medication, and identify strategies that can support patients to be ore adherent during these periods. For examples targeted messages (SMS) sent to patients during festive periods.

Escalation Strategy: Use dosing histories to identify non-adherent patients and escalate such patients to more intensive management care, this is referred to as patient differentiated care.

Customised Messaging: Send targeted educational (or motivational) messaging to groups of patients based on their adherence, risk factors, or stage of treatment .


Country examples: The Philippines 99DOTS

Differentiation of care pathway designed based on current standard of care



 

Questions to ask in setting up differentiation of care pathway

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Questions to answer in setting up DAT intervention approach

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Differentiation of care pathway designed based on current standard of care


Tools and resources

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