Transcript Document
Implementation of patient-centered medical records for short term mission trips in rural Haiti Nabil Background The World Health Student Organization (WHSO) of the Wayne State University School of Medicine (WSU-SOM) is committed to providing free health care to underserved areas around the world, utilizing service-learning in global health education and to raise global health awareness. In February and March of 2014 the WHSO sent two teams consisting of medical students and physicians to Morne, Haiti; a rural, mountainous region near the capital of Port-au-Prince. In rural regions of Haiti, few citizens have access to healthcare. Much of the healthcare is carried out by mission trips, which may or may not communicate with one another. Providers from one group may be unaware of the medications prescribed by previous groups, a problem exacerbated by lack of medical records. The purpose of this study is to describe a medical records system that was implemented across two short-term medical mission trips to Morne which facilitated follow up care across a wide spectrum of medical disorders. 1 Othman , Francis Chih Chuang, 1Wayne State University School of Medicine The record system consisted of a booklet, created by our host organization Rays of Hope and distributed by the WHSO, with the following information: 1. Patient name 2. Vital sign measurements: height, weight, temperature, pulse and blood pressure 3. Medical diagnoses 4. Medication/therapies administered In February, the booklet was given to patients after their discharge from the clinic. Those designated as follow up patients were encouraged to return when the second team arrived in March. 1 M.D. Patient Diagnoses All Patients Anemia GERD Parasites Headache HTN URI Vag Infection Allergies Tinea Capitis Back Pain Abd Pain UTI Scabies Fungal infection Pneumonia Cough Dry eyes Dysmenorrhea Generalized Pain Ear infection Pregnancy Impetigo Knee Pain Constipation Bacterial Vaginosis Tinea Corporis Asthma 123 113 86 57 52 50 48 43 39 33 32 32 28 20 18 18 16 16 15 15 14 14 12 12 11 11 10 Conditions with n>10. Represents 75.6% of total diagnoses The Record System 1 Tinney , RESULTS Follow Up Patients HTN GERD Fungal Infection Allergy Bacterial Infection Asthma Back Pain Headache Osteoarthritis Generalized Pain Diabetes MellitusType 2 Dry Eyes Knee Pain UTI COPD Gastritis Hernia Insect bite Parasitic Infection Sciatica Catarcts Dilated Cardiomyopathy Dry Skin Dysmenorrhea Impetigo Joint Pain World Health Student Organization 52 25 18 13 10 9 8 7 7 7 6 6 6 5 4 4 4 4 4 4 3 • • • • • • 107 total follow up patients 13 followed up, confirmed by name on intake form 9 of 13 patients had high blood pressure as primary diagnosis. 8 of 9 presented with lower blood pressure Average blood pressure drop was 25.4 (12.1) mmHg March mission trip carried out a survey of clinic patients: 95% of those surveyed (n=40) supported this new record system Follow Up Patients Hypertension Back Pain Ascites 3 3 3 3 3 Conditions with n>3. Represents 83.7% of total follow up diagnoses Different Patient Profiles CONCLUSIONS The average follow up patient had a different diagnosis than the average clinic patient. Follow up patients were chosen based on their clinical diagnoses: those who suffered from chronic conditions that require monitoring, such as diabetes and hypertension, were more likely to be chosen as follow up patients. Overall hypertension was the most common disease among follow up patients, where as in all clinic patients anemia, GERD, parasitic infection and headaches were more common. Of all clinic patients 4.2% were diagnosed with HTN, whereas that percentage increases to 23.5% in follow up patients. 1. This pilot medical record book showed utility as a system to track the blood pressures of hypertensive patients. 2. Medical record booklets keep health records in the hands of the patient population, so any medical mission trip has access to them while treating patients. 3. The low follow up rate could be explained by human error: names could be recorded incorrectly, resulting in an artificially deflated follow up rate. The actual rate is likely higher than reported. Tracking patients by name is likely to be unreliable. 4. It is a potentially effective way to facilitate follow up care for short term medical mission trips .