Abstract #363  -  Effectiveness of arv nurse prescribers in peadiatric arv provision: the experience of the botswana-baylor childrens clinical centre of excellence (coe)
Authors:   Presenting Author:   X Jibril -
Additional Authors:
Aim: Background: Given the shortage of physicians in Botswana, the Baylor-affiliated Pediatric Infectious Disease Clinic (PIDC), in collaboration with the Ministry of Health Nurse Prescriber Program, trained 5 nurses in the care of stable HIV-infected patients. These nurses, trained in the final quarter of 2008, are currently the only nurses currently offering full-time pediatric HIV care in the country. OBJECTIVES: To demonstrate the effectiveness and quality of pediatric HIV care provided by nurse-prescribers, and compare the thoroughness and appropriateness of such care with that of experienced physicians practicing in the same center.
Method / Issue: Design/Methods: Stratified random sampling was used to select encounter forms from 30 nurse-patient encounters and 30 doctor-patient encounters from January 2009. These visits were audited to assess the completeness of each visit, including: 1) pill count; 2) complaints charted; 3) social changes/history charted; 4) disclosure; 5) physical exam; 6) lab tests; 7) WHO staging; and 8) pediatric dosing. Average compliance scores were calculated for 3 nurses and compared with practicing physicians; Z-scores were used to determine any statistical differences between the performances of the two provider groups.
Results / Comments: Results: In January- March 2009, there were 2542 patient encounters, 25% completed by nurse prescribers. Average daily consultations were similar (10.6 and 11.1 for nurses and physicians, respectively). Results are below: Task Nurse provider (%; n=100) Physician provider (%; n=100) 1) pill count 100 97 2) complaints charted 100 99 3) social changes/history charted 95* 88 4) disclosure 97 92 5) physical exam 95 96 6) lab tests 91 91 7) WHO staging 96 96 8) pediatric dosing 97 99 *p <0.05
Discussion: Conclusions: With short-term training and support, nurses can provide high-quality and cost-effective pediatric ARV care. Nurse prescribers are as effective at following national guidelines for stable pediatric HIV positive patients as physicians for the indicators in this study.
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