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Apr 29
Systems thinking: How an innovative idea boosted the CCMDD patient return rate at Reservoir Hills Clinic

​By: Presha Gopaul (Post-Basic Pharmacist Assistant), Nonhlanhla Sithole (Pharmacist), and Roma Ramphal – CCMDD Provincial Co-ordinator, KwaZulu-Natal

Since the Central Chronic Medicines Dispensing and Distribution (CCMDD) programme was launched in eThekwini in 2016, many challenges have been identified and resolved through system and process changes. However, a persistent challenge has been the return of CCMDD patients to facilities for clinical review.

That is, until now. 

Patients who do not attend a clinic in due time for their medical check after collecting their medicine parcels at an external pick-up point run the risk of being de-registered from the CCMDD programme, because missing a clinic appointment is likely to be a sign of treatment interruption.  A person's chronic illness has likely not been managed, and so their health becomes clinically unstable.

During the last few months there was a significant spike in the number of patients who had missed their scheduled CCMDD review dates and this is of great concern. This could be because patients lose or forget to check their CCMDD Collection Cards, or are unable to get time away from work.

CCMDD patients receive a reminder SMS from the service provider, Pharmacy Direct, generated by SyNCH (the CCMDD electronic system) to remind them of their medicine parcel collection date – but no SMS reminders are issued about returning to the clinic for a check-up and prescription renewal.

Many patients rely on Pharmacy Direct's reminder message for collection of their medication, because it reassures them that their parcel is ready and waiting at the pick-up point. Why not apply the same concept for patient review and prescription renewal?

https://www.hst.org.za/PublishingImages/Presha%20Gopaul%2C%20an%20HST%20Post-Basic%20Pharmacists%E2%80%99%20Assistant%20at%20Reservoir%20Hills%20Clinic.jpgPresha Gopaul, an HST Post-Basic Pharmacists’ Assistant at Reservoir Hills Clinic, came up with anovel idea to introduce a system of bulk SMS reminders to patients alerting them to the dates of their clinical review appointments. 

Presha used SyNCH to extract the 'Expected Patients Return Report', which lists patients' appointment dates for prescription renewal. For three consecutive weeks (between 15 March and 2 April 2021), Presha used her personal cellphone with her own data bundles to send SMS reminders in isiZulu and English to the listed patients.  

Of the 101 patients who were sent SMS reminders, 82% visited the facility for review.

https://www.hst.org.za/PublishingImages/InkedScreenshot%20of%20a%20bulk%20SMS_LI.jpg

Screenshot of a bulk SMS

Patient interviews were conducted in the third week of the trial period to determine whether the reminder was helpful. Of the 15 patients interviewed, 11 patients received the SMS and found it helpful and 13 patients confirmed that they would like to receive the reminder SMS routinely.

Patient Gina David said:

"I was excited to receive a reminder SMS. I would like to continue receiving the SMSs because sometimes I forget my clinic date or misplace my clinic card and do not remember my date. It also gives me a sense of feeling that the facility staff cares about my well-being. The SMS has also made it easier for me to request leave from my employer to attend the clinic."

https://www.hst.org.za/PublishingImages/Patients%20received%20the%20SMS%20and%20returned%20on%20their%20scheduled%20date.jpg

Patients received the SMS and returned on their scheduled date.

The initiative is successful because patient care is continued and maintained, and they also feel a sense of belonging. Patients are motivated to take charge of their own health and return to the facility timeously.

A special thanks to Reservoir Hills Clinic Nursing Services Manager, V A Francis, for allowing Presha and Nonhlanhla Sithole, the supporting Pharmacist, the opportunity to implement this strategy. 

With the assistance of the SA SURE Plus Programme, there is a plan to extend this strategy to all HST facilities in HST's supported districts in KZN. 








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