Health Cards (21)
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William asks how the cards might be evaluated.
Some ideas-
Before anything else, state explicitly a list of likely benefits and harms.
Keep it short, and priority order them. These are going to be your outcome
measures, so think about it .You may also want to include some of the
privacy issues brought up by several correspondents.
Then, with these in mind, do a systematic literature review of existing
patient held records (see Jeremy Grimshaw's contribution) to see what
lessons have already been learned.
Follow this up with formative evaluations - how much information collection
are health workers happy to do, and use, how much information are people
and patients prepared to give, how accurate is this information.
This stage would be small surveys, lots of qualitative work as well.
When this has allowed you to design a card which seems it might be useful,
implement it in one or two sites to test its acceptability to staff,
patients and managers, and the loss rate by patients.
My sense from your early email is that you have done all of this, except
the review (!), on a card, but its not clear that its this one- if not, I
guess you would have to redo. And the review is indispensable.
When all this is done, do a randomised trial- probably randomise clinics or
health districts- depending on the effect size you are looking for the
study is likely to be quite manageable in size.
See the Mwanza STD treatment trial as a shining example.
More details available if you are going to conduct an evaluation of
effectiveness. I think it would be very good if you did do such an
evaluation. There are untold examples in our countries where solutions
turned out not to be, and should have been evaluated before being
implemented.
Merrick Zwarenstein
Division Head,
Health Systems Division,
Centre for Epidemiological Research in Southern Africa
Medical Research Council
PO BOX 19070, Tygerberg, South Africa, 7505
STREET ADRESS:
Fransie van Zyl Drive, Parow, South Africa, 7500
Tel. +27-21-938-0247
Fax +27-21-938-0342
mailto:mzwaren@eagle.mrc.ac.za
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