Document

Report
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 .

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