Buddy Systems and sending Patient Reminders
Jeff Rafter
Nina Jansen
I see your point. How about this: on their next visits all patients
are told that the clinic is setting up local support groups, and ask
if they would be interested in such a group. Being in the group would
mean having someone to travel with and someone to talk to. If they say
yes, next time they come, people that have said yes and are from the
same area could be introduced and connected to each other.
You could also ask the patients if they agree to be contacted by cell-
phone. In general, you could see it as market research: is there any
interest in such a system? Even if you can only reach some patients,
it would still be an improvement.
:-)
Nina
On Sep 22, 6:08 pm, "Jeff Rafter" <jeffraf...@gmail.com> wrote:
> Hi All,
> Nina and others have brought up some interesting ideas about creating buddy
> systems and using twitter to contact patients with reminders. I thought we
> should spin up a separate thread about it. We have actually talked quite a
> bit about these kinds of possibilities but never settled on any solutions.
> As I see it the primary problems here are not exactly technical. Mainly,
> being HIV positive in Malawi carries a huge stigma (as it would anywhere
> else). Because of this, it is our job to do everything we can to keep this
> information private-- and Malawians are savvy. As an example, at one clinic
> HIV patients were being issued a second identification number for the
> Anti-retroviral clinics. Although no one could decode the number-- just the
> fact that you had two numbers meant you went to the clinic and therefore had
> HIV. Ultimately we needed to change the system so there was no longer a
> visual indicator (even if it was very small).
>
> So sending messages via twitter would be extremely useful, and having buddy
> systems very helpful. But we need to do it in such a way that it is not
> obvious or detectable. Also, it is common to share phones so we need to be
> sure who the recipient is. We have talked about increasing the amount of
> noise in the channel to drown out the signal (e.g. using the same system to
jin...@gmail.com
health personnel
as every patient that is initiated is asked whether "they agree to be
visited at home"
by the hospital's home based care team.
Introducing the buddy system, would also help patients to encourage
each other to
take their medicine. Informally buddy systems exist at the hospital,
mainly in terms of visit
dates, as patients that start on the same day will likely have the
same visit dates to the
clinic, all conditions being normal.
However extending this informal buddy system that exists now, to
location based buddy system
would be a something worthwhile discussing with the hospital
management.
Nina Jansen
My suggestion is the following: suppose you see patients once every
week, Monday through Friday. That means that a patient can come in on
5 different days. Then you divide you district up into 5 regions.
Region 1 comes on Monday and so on. Suppose a patient lives in region
3, i.e. is supposed to come in on Wednesday, but come in Friday. For
two weeks, that patient should have only 6 days between appointments
before he/she has been rotated to a Wednesday schedule. At the same
time, you find someone someone has to be rotated away from Wednesday
to Friday. That patient will have 8 days between appointments until he/
she lands on Friday. This means that the switch can be done gradually,
exchanging patients between days until everyone from the same
geographical region comes in on the same day.
It is important to make the right 5 regions. They should have roughly
the same amount of patients, and you should be able to predict that
the distribution between regions stays roughly th same. For this you
would need to look at the data you already have. Also for the support
system to work, people living close to each other should be in the
same region.
:-)
Nina