Bangladesh Diarrhoea Study - Clinical Encounter Observation Form

ANNEX E: EXAMPLES OF STRUCTURED OBSERVATION PROTOCOLS

Example 1: Bangladesh Diarrhoea Study - Clinical Encounter Observation Form

Example 2: Bangladesh Diarrhoea Study - Dispensing Process Observation Form

Example 3: Nigeria Malaria Study - Clinical Process Observation Form

Example 4: WHO/CDD Drug Sellers Study - Pharmacy Encounter Observation Form Example 1: Bangladesh Diarrhea Study - Clinical Encounter Observation Form

IDENTIFYING INFORMATION

Health Facility: ______Dept:______Date:______

Visit ID: ______Time of Visit:______

Patient Age (yrs,mos): ______Sex:______Accompanied by: ______

PRESCRIBER-PATIENT INTERACTION

Length of Clinical Consultation (minutes): ______Provider Type: ______

DIAGNOSTIC COMMUNICATION Prescriber

Patient

Volunteered

Discussed

Length of diarrhoea episode

______

______Association of onset with foods eaten ______

ANNEX E - 1 ______

______Diarrhoea frequency/volume

______

______Appearance of Stool

______

______Child still eating/drinking/breastfeeding ______

______

______Previous treatment for this episode

______

EXAMINATION/TREATMENT Examined Not Does Examined Not Apply

Temperature (measured or felt)

______

ANNEX E - 2 ______

______Pulse

______

______Skin turgor

______

______Fontanelle (if child under 6 months) ______

______

______Diaper examined (if soiled)

______

______Stool culture ordered

______

______Sterile technique followed for injection ______

ANNEX E - 3 ______

______

COMMUNICATION/ADVICE

Prescriber

Patient

Not Initiated

Initiated

Discussed Specific drugs/injection desired

______

______Information on drugs prescribed

______

______Eating/feeding/breastfeeding advice ______

______

______Information about diarrhoea prevention ______

______

ANNEX E - 4 ______

ANNEX E - 5 DESCRIPTION OF CLINICAL ENCOUNTER

1. Patient greets prescriber Yes ______No ______

2. Prescriber reciprocates greeting Yes ______No ______

3. Friendly conversation Yes ______No ______

4. Reassurance to the child Yes ______No ______

5. Reassurance to the adult Yes ______No ______

6. Friendly eye contact with adult Yes ______No ______

7. Encouraged to describe problem freely Yes ______No ______

8. Doctor ask questions about history, origins of problem? Yes ______No ______

9. Doctor listens to responses Yes ______No ______

10. Doctor explains exam, treatment Yes ______No ______

11. Doctor uses technical language only Yes ______

ANNEX E - 6 No ______

12. Clinical encounter ends abruptly Yes ______No ______

13. Adult appears to want more advice or information Yes ______No ______

14. Adult appears to expect additional treatment that was not given Yes ______No ______

15. Adult appears to understand child's disease and treatment after doctor's explanation Yes ______No ______

OBSERVER NOTES AND COMMENTS:

ANNEX E - 7 Example 2: Bangladesh Diarrhea Study - Dispensing Process Observation Form

DISPENSER-PATIENT INTERACTION

Length of dispensing process (seconds): ______Dispenser: ______

Type: ______

COMMUNICATION

Prescriber

Patient

Initiated

Discussed Description of the drugs dispensed

______

______Instructions on how to take drugs

ANNEX E - 8 ______

______

______Cautions, side effects mentioned

______

______Information about prevention/care

______

DISPENSING ACTIONS Yes No Does Not Apply Sterile technique followed for injection ______

______

Drugs labeled with (Check one or more):

Patient name:______Drug name: ______How to take:______No label: ______

Type of package in which drugs dispensed (Check one or more):

Plastic/glass bottle: ______Plastic bag: ______Envelope: ______Folded paper: ______None: ______

ANNEX E - 9 DESCRIPTION OF THE DISPENSING ENCOUNTER

1. Conversation initiated by dispenser Yes ______No ______

2. Conversation initiated by patient/caretaker

______No

______

3. Explanation given by dispenser

______No

______

4. Questions raised by patient/caretaker

______No

______

5. Dispenser answered patient questions

______No

ANNEX E - 10 ______

6. Dispenser explained about drugs

______No

______

7. Dispenser used technical language only

______No

______

8. Dispenser used local language

______No

______

9. Patient/client asked for more drugs Yes ______No ______

10. Dispenser marked unavailable drugs on prescription

______No

______

ANNEX E - 11 11. Dispenser told patient/client to buy unavailable drugs at outside store Yes

______No

______

ANNEX E - 12 Example 3: Nigeria Malaria Study - Clinical Process Observation Form

PRESCRIBER - PATIENT INTERACTION

Length of Clinical Consultation (minutes)______Provider Type:______

DIAGNOSTIC COMMUNICATION Prescriber

Patient

Volunteered

Discussed

Length of current episode?

______

______Patient mentions malaria?

______

ANNEX E - 13 ______

______Previous treatment for this episode? ______

______

______Last time treated for malaria?

______

______Name of drug used to treat last time? ______

______

______Finished last course of treatment?

______

______Risk factors (near river, near bush, mosquitoes, etc.)?

______

______Communication about presence of: fever?

______

ANNEX E - 14 ______

______headache?

______

______malaise?

______

______muscle weakness?

______

______loss of appetite?

______

______chills?

______

______vomiting?

ANNEX E - 15 ______

______

______metal taste in mouth?

______

______If patient is a child: Child-vomiting?

______

______Child still eating/drinking? ______

______

EXAMINATION/TREATMENT Examined

Does Examined Not Apply Temperature measured?

______

______Patient touched for fever?

ANNEX E - 16 ______

______

______Pulse felt?

______

______Sclera of eyes examined?

______

______Tongue examined?

______

______Listens to chest?

______

______Palpates abdomen?

______

ANNEX E - 17 ______

ANNEX E - 18 TREATMENT

Does Not Apply Injection given?

______

______Sterile technique followed for injection? ______

______

______Advised lab test?

______

______Advised exam at different facility?

______

______Advised return visit if not better?

______

ANNEX E - 19 ______

COMMUNICATION/ADVICE

Prescriber

Patient

Not Initiated Initiated

Discussed Patient asked for: injection?

______

______chloroquine?

______

______halfantrine?

______

______other specific drug?

______

______Provider explained drugs prescribed? ______

ANNEX E - 20 ______

______Provider advised about mosquitoes? ______

______

______Provider advised about prevention? ______

______

______Provider advised about nutrition?

______

QUALITY OF PROVIDER-PATIENT INTERACTION

Yes No Does Not Apply Patient greeted prescriber? ______

______Prescriber greeted patient? ______

______Friendly conversation? ______

______Provider reassured patient? ______

______

ANNEX E - 21 Patient encouraged to describe problem freely? ______

______Doctor listened to responses? ______

______Encounter ended abruptly? ______

______Patient appears to want more information? ______

______

ANNEX E - 22 Example 4: WHO/CDD Drug Sellers Study - Pharmacy Encounter Observation Form

Age of person with diarrhoea: (1=< 1 year / 2=1-4 years / 3=5 and over): ______Identity of person visiting shop (1=mother / 2=father / 3=sibling / 4=other): ______Presence of absence of prescription: (1=came with prescription / 2=no prescription) ______Sales attendant type (1=Pharmacist / 2=Assistant Pharmacist / 3=Other): ______

1. Which of the following issues were discussed during the visit? Sales Attendant Customer Not Mentioned First Mentioned First Discussed Presence of fever / blood in stool ______Presence of vomiting / stomach pains ______Dehydration / loss of fluid ______Food, fluids, or drugs taken by patient ______Description of what specific drugs do ______Use of traditional remedies ______Use of ORS/ORT ______Proper dosage / frequency of drugs ______Cautions / side effects of drugs ______

2. Which of the following did the shop attendant recommend?

Visit a doctor if the diarrhoea persists, child vomits, or runs a fever ______Continue to give fluids and foods, or increase fluid to prevent dehydration ______

If advice was given: What was the customer's reaction to the advice? (1=Accepted without question / 2=Accepted but asked questions / 3=Accepted after persuasion) / 4=Did not accept) ______

3. Which products were recommended? Write 'NONE' if none were recommended. # of Units # of Units Price Name Recommended Purchased Paid

a.______

ANNEX E - 23 b.______

c.______

d.______

e.______

4. Who seems most responsible for the treatment given: a medical practitioner, the sales attendant, or the customer? Explain why, and describe any factors you feel influenced the behaviour of the sales attendant or customer.

______

ANNEX E - 24