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INFLUENCE OF PATIENT RECORDS MANAGEMENT PRACTICES, DISEASE SURVEILLANCE AND NOTIFICATION SYSTEMS ON EPIDEMIC CONTROL IN OSUN STATE, NIGERIA

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CHAPTER ONE

INTRODUCTION

1.1.      Background to the Study

The effectiveness of epidemic control activities in local government areas in Nigeria require accurate and adequate patient’s record management as documentary evidence of the care and treatment which the patient received in the hospital. Patient records are clear, concise and accurate history of a patient’s life and illness, written from the medical point of view. They are collection of recorded facts concerning a particular patient, his or her illness and the events occurring in the course of professional care for the purpose of providing the best medical care to the patient, for teaching, research, study appraisal of medical practice and legal requirements (Benjamin, 2001). Osundina (2014) opines that patients’ records contain history of illness, medical investigations and tests, results of examinations, diagnosis and treatment. Patient’s record helps in the planning process through availability of health data, which serves as a record of response to patient’s health conditions and as a guide to future therapy. Hence, records should be managed to serve the purpose for which they were created.

Popoola (2008) describes records management as the area of general administrative management, concerned with achieving economy and efficiency in the creation, maintenance, use, and disposition of patient information, during their entire life cycle. It is the application of the systematic and scientific control over recorded information that is required in the operations of an organization’s business. Such control is exercised over the creation, distribution, utilization, retention, storage, retrieval, protection, preservation and final disposal of all types of patient information within an organization.

The healthcare provider makes an entry into the medical records with the actual occurrence of the event. The ability to maintain accurate and timely record is critical for the delivery of quality patient care, as well as for efficient disease surveillance and notification systems that will guarantee effective disease epidemic control within a geographical area. Omole (2015) submits that for any patients’ records management system to be efficient in any health institution, there must be a health records department with adequate space, equipment and trained personnel. Accurate and complete health records must be written for all patients and the records must contain identification, demographic and clinical data to justify the diagnosis and warrant the treatment given. Also all entries must be signed by responsible person and patient records must be filed, organized, and stored in an accessible manner, in a secured place in the health institution. Therefore, records currently useful in disease surveillance activities should not be destroyed because of the possibility of impending disease epidemic that may warrant case investigation. Records are managed according to the retention schedule. Once the record management life cycle of a record has been satisfied according to the predetermined period and there are no legal holds pending, it is authorized for final disposition, which may include destruction, transfer, or permanent preservation (Hipper, 2008)

Effective application of records management life cycle is critical to the management of patients’ records in the local government health facilities in OsunState. Popoola (2000) asserts that recorded information has a life similar to that of a biological organism in that, it is born (creation phase), it lives, (maintenance and use phase), and it dies, (final disposition). He went further to state that as soon as patient records are created in the hospital during registration, consideration must be given to storage facilities, retrieval tools, filing and classification. Therefore, if the hospital management fails to act on the mentioned issues the growth of records can consume the available space in the hospital, and cause inefficiency and poor management of patient health records.

The records life cycle is applicable to patient records management practices, which covers the life span of patient record from its creation to its final disposal. Patient records creation starts with the documentation and registration of patient in the health information management department of an health institution. This will be followed by entering of clinical information such as; patient’s complains, diagnosis, reports of medical investigations and treatment rendered into the record. At the registration point, a unique hospital number would be assigned to the patient record to facilitate distinct identification of the record.

The records maintenance phase involves storage facilities, retrieval tools, filing and classification. This is applicable to patient records management practices because effective maintenance of patient records requires the adoption of appropriate filing system, numbering system, appointment system, tracing system, storage system, coding and indexing systems. Applications of these systems enhance accessibility to patient records for an efficient disease surveillance and notification systems.

Patient record’s use begins with an initiation stage, during which the information user first becomes aware of the need to gather information from the existing records, by recognizing the initial need for information, and attempt to facilitate effective use of the records through systematic organization pattern of the patient records based upon his / her needs. Coding and indexing systems are the tools that facilitate patient records use. These systems involve the process of assigning numeric or alphanumeric representations to clinical documentation (i.e. specific diseases, diagnoses and or procedures) as stipulated in the classification system such as International Classification of  Diseases, volume 10  (ICD-10). Indexing on the other hand is the process of preparing a catalogue which denotes the various processes involved in the preparation of entries and maintenance of a catalogue. Coding and indexing are processes of grouping which involve putting together like entities and separating unlike entities by assigning a classification mark to an item through which the item may be easily identified and located for use when the need arises (Ayegbayo, 2009).

Evaluation is a process of determining the value of records for further use, and the length of time for which that value will continue. Evaluation must be done based on the existing policy, which will stipulate how long records should be kept in their original form and what to be done after the expiration of the stipulated period. Record’s content, record’s value, record’s form, reference value, research value, operating value, fiscal value, legal value, and archival value of the records must be considered during the evaluation process. Evaluation helps in the categorization of patient records into active, semi-active and inactive records (Suleiman, 2010).

Active patient records are records needed to perform current operations (such as direct patient care and treatment) they are subject to frequent use and usually located near the user, and may be managed in a centralized or decentralized health records library. Furthermore, semi-active phase occurs, when the patients have been discharged home and only need to visit the hospital on appointment or at will. Records of discharged patients are processed in the health information management department and stored in the health records’ library. These categories of records are seldomly retrieved for patient care and research purposes.

An inactive record is a record that is no longer needed to conduct current business but is being preserved until it meets the end of its retention period as stipulated in the enabling policy.  Inactive patient records are those records that are dormant on the shelves, which their owners or the patients have cease coming to the hospital, over a given period of time and records of dead patients that are kept in the health records library. These categories of records are made to reside in the secondary storage area of the library in order to create space for active records on the shelves, because of their reference value during disease surveillance and notification activities especially when carrying out trend analyses of diseases over a period of time (Makata, 2015).

American Health Information Management Association (2011) views records management in the health care industry as a special program in health information management which involves not only maintaining patient files, but also coding the files to reflect the diagnoses and operations of the conditions suffered by patients. Developing and implementing policies, procedures and guidelines necessary for effective filing, storage and to make available both physical and electronic health records for patient treatment in the hospital, in accordance with the state and federal laws, will improve the availability and security of patients’ information and guarantee continuity of patient care (Huffman, 2001).

Basically, patients’ records can be used in two ways: for clinical uses and for non – clinical uses. Austrian (2003) buttresses that, clinical record serves as the recorded facts on clinical care rendered to the patient, which provides a medium for various medical disciplines to communicate about a patient’s illness and course of treatment, supplies information to care givers, serves as a primary source of information for research by medical, nursing and community efforts, to control disease and monitor the overall health status of a population. Non-clinical uses of patients’ records include use by insurance companies, legal advisers, researchers, international health agencies, government / private employers to substantiate claims and to monitor the appropriateness of care and service rendered to a patient.  Therefore, patient records management practices consist of the provision of appropriate infrastructure, the establishment of mechanisms and procedures, for collecting and analyzing health data to provide needed information, to be used as a management tool for informed decision making at all levels of health care delivery system (National Health Management Information System Policy, 2006)

Disease surveillance and notification system involves the process of maintaining a constant watch on the trend of occurrence of diseases within a geographical area through systematic data collection and processing on mortality and morbidity, and prompt reporting to the appropriate health authority for further necessary action (Omole, 2008), which is a watchful, vigilant approach to information gathering that serves to improve, or maintain the health of the population. A functional disease surveillance system is essential for defining health problems and taking action. The application of epidemiological methods in the service of surveillance, equip local government areas and local health team to set priorities, plan interventions, mobilize and allocate resources and predict or provide early detection of outbreaks (Federal Ministry of Health, 2014). Fawole (2006) also posits that, disease surveillance and notification involve the ongoing and systematic collection, analysis and interpretation of health data in the process of describing health events. The information thus gathered, is used for planning, implementing and evaluating public health interventions and programs. Also, various surveillance data are used to determine the need for public health action and to assess the effectiveness of the program. The role of a good and effective reporting system cannot be overemphasized in the administration of disease control and their treatment. If reporting system is good and effective, it serves as a good source of health information or data bank towards diseases epidemic control. It is important to note that no epidemic control measure can actually be put in place without effective and efficient disease surveillance and notification system.

Disease surveillance and notification system was introduced in 1988, following a major outbreak of yellow fever in 1987, which affected ten out of the then nineteen states of the federation. The magnitude of the outbreak was attributed to weak or non-existence of disease surveillance and notification system in most states. As a result of this, a task force was established by the Federal Ministry of Health to review disease surveillance and notification in the country and between 1988 and 1989, disease surveillance and notification system for the country was developed. Forty diseases of public health importance in the country were identified and designated for routine (monthly) notification out of which ten epidemic diseases were selected for immediate reporting. Standard reporting forms [Disease Surveillance and Notification (D.S.N.) form 001 for immediate reporting, and DSN form 002 for monthly routine reporting] were also introduced and the methodology for information flow between the various levels was also prescribed, i.e. from Health Facility, to Local Government Area (Health Office), from Local Government Area to State Ministry of Health (S.M.O.H.) and from state to Federal Ministry of Health (F.M.O.H) level (Oyeniran, 2013).

Hence, in 1989, the National Council on Health approved the adoption of disease surveillance and notification system (DSN) in the country based on the recommendation of the task force committee and subsequent compliance and implementation by the Federal Ministry of Health enabled the system gain its recognition in the local government presently.  The Federal Ministry of Health and Human Services guideline on surveillance and notification of diseases in Nigeria, (1991) defined disease surveillance and notification system as a system of constant watchfulness over all aspects of occurrence and spread of diseases, which are relevant and important for effective control of such diseases (Oyeniran, 2013). The information thus gathered is used for planning, monitoring, implementing, evaluating as well as for the recognition, control and prevention of disease epidemics. Surveillance data are used to determine the need for public health action and assess the effectiveness of the program. Over the years, communicable diseases are leading in the causes of death and disability among Nigerians, especially those living in the rural areas. To minimize these effects, there must be quick intervention aimed at providing medical care for the affected people and also provide health education to create awareness concerning prevailing health problems and the methods of preventing and controlling them. The acceptance of modern health care in some local government areas of Osun State is still not encouraging because some people in the rural areas still believe in traditional theory of disease cause such as taboos, witches, wizards, and so on, instead of acceptance of scientific method such as  orthodox medicine application (Adegbesan, 2014).

It is pertinent to note that authorities of local governments in Nigeria have designed programs and strategies to discharge the responsibilities assigned to them under the constitution to meet the health care needs of their people with the general guidance, support and technical supervision of the state Ministry of Health. The Local Government provides essential infrastructures for primary health care programmes and maintains them accordingly. Authorities of local governments give supportive action to each component of health programs, health education on importance of immunization and provides relevant health information to the people on personal hygiene, environmental sanitation, prevention and control of communicable diseases as well as such matters where a change in the life styles of the people can have significant impact on their health status.

Furthermore, epidemic control programme will only be effective when reliable mechanisms of data collection, analysis and retrieval are in place with full co-operation of all persons and organisations concerned, and with an effective disease surveillance and notification system. Disease notification is the official reporting of designated diseases to the appropriate health authority, and the purpose of disease notification is to provide necessary and timely information to permit the appropriate institution work out epidemic control measures as well as ensure uniformity in morbidity management (Fatiregun, 2012). The surveillance activity objective, guide program managers towards selecting data, which are useful and relevant for making evidence-based decision for public health actions based on the goal of the disease prevention program.

Lucas & Gilles (2003) define surveillance as a system of constant monitoring of all aspects of the occurrence and spread of diseases and use of the information thus gathered for prevention and control of the disease in question. The characteristics of a good surveillance system have been grouped in terms of five domains by Lucas and Gilles: The public health importance of the health event (disease or condition) under surveillance, the usefulness of the system, the event under surveillance, the flow of data within the system and the components of the system, a series of the epidemiological attributes of the system such as; simplicity, flexibility, acceptance, accuracy (sensitivity and specificity) representativeness and timeliness, and the resources required to operate the system.

Disease notification involves the official report to the appropriate health office at specific level, the occurrence of specific or notifiable disease, due to their effect on public health, while a system is a set of interrelated components, that interact together to perform a given task towards achieving a specific goal or objective. The usual sequence of event model that identified prompt identification of first case, detection and reporting, laboratory confirmation, and response, as the four sequences of events that must be regular part of health care delivery services is relevant to disease surveillance and notification system. The implementation of various components of disease surveillance and notification systems is to timely generate information for appropriate public health action, these include: detecting, investigating, reporting and managing cases and outbreaks, collecting and compiling data, analyzing and interpreting data, producing routine reports of the data and providing information to decision makers at the higher level and feed back to the peripheral levels.

Findings from pilot study revealed that, infant mortality and morbidity rates among the children, due to diarrhoea, measles, malaria, and respiratory infections, are constant reminders of the heavy toll which these communicable diseases exert on the people living in various local government areas of Osun State. In order to minimize these effects, there must be quick intervention, aimed at providing medical care for the affected people and also give health education to create awareness concerning prevailing health problems and the methods of controlling disease epidemics. The implementation of these interventions is called epidemic control.

Epidemic control is the process of curbing, checking, or regulating unusual occurrence of infectious disease(s) among the people within a geographical area. Epidemic is the occurrence of a number of cases of a disease, known or suspected to be infectious or of parasitic origin, that are usually large or unexpected for a given place or time. An epidemic often develops rapidly, so that a quick response is required (Federal Ministry of Health, 2011). There is threatened or potential epidemic, when the circumstances are such that the epidemic occurrence of a specific disease may reasonably be anticipated. This requires, susceptible population, the presence of impending introduction of disease agent, and the presence of a mechanism that large scale transmission is possible. (e.g. contaminated water supply, a vector population and importation of a contagious disease victim such as Ebola case). This established the fact that epidemics usually result into loss of human and economic resources, it usually pose political difficulties, if allowed to continue, can throw the town, Local Government Area, State, country or even a continent into total disarray and complete chaos.

Epidemic control involves the knowledge of the occurrence and distribution of diseases including the strategies of curbing or preventing them. The epidemiological division of the ministries of health in the state and national levels are responsible for conducting epidemiological surveys into some diseases that are infectious in nature. This results in the quick detection of epidemic and the provision of appropriate action for timely control of disease epidemics. Hence, epidemic control in the local government areas of Osun State requires the need for accurate, high quality health information, at the right place and at the right time, as indicated by information sharing for public health action theory which placed premium on use of surveillance information for epidemic control. This calls for health records management practices that can gather, organize, analyze, and summarize data into reports and assist in the successful carrying out of an active disease surveillance and notification systems that will result in effective epidemic control in local government areas of Osun State (Omole, 2015).

Epidemic control outcomes should result into curbing, checking, or regulating unusual occurrence of infectious disease(s) among the people within a geographical area, via the use of valuable information as indicated by information for public health action theory. This is why the relevance of control measures in disease epidemic control activities cannot be underestimated, because they contribute to reduction in morbidity and mortality, reduction in incidence rate of diseases and total stoppage of a disease epidemic. Availability of timely and relevant health information is also essential in epidemic control for mobilization resources for specific health intervention.  It is at this instance that the researcher investigated the influence of patient records management practices, disease surveillance and notification systems on disease epidemic control in local government areas of Osun State.

Osun – State came into existence on August 27, 1991 as a result of the creation of another State out of the former Oyo State by the then Federal Military Government. The State which has Osogbo as its capital has an area of approximately 8,602 square kilometers and is bounded in the West by Oyo State, in the East by Ondo State, in the North by Kwara State and in the South by Ogun State. The State is made up of thirty local government areas and the highlights of the local government areas, their headquarters and total population are stated in the appendix. Osun-State administration is headed by an Executive Governor, assisted by some commissioners and Permanent Secretaries. The administration of the 30 local government areas is run into two main streams viz: the legislature and the executive. The legislative arm is made up of the leader of the Local government council, the principal officers of the legislative council, and other councilors. The executive arm is made up of the local government chairman, secretary and supervisors, who are either appointed or elected. The head of local government administration and other directors oversee the functions of each department and are directly responsible to the executive chairman with whom they deliberate on the day to day running of the local government (Osun State Local Government Service Commission, 2016).

The primary health care department of each local government area provides the largest percentage of all medical and health services through primary health care system which brings healthcare services very close to where people live and work, with the assistance of state government, federal government, and international health agencies. Also, patient records are managed in these primary health care facilities and surveillance activities are carried out by designated officers in order to monitor health events and prevent disease epidemics within their catchment areas for the purpose of improving the health status of the citizens (Ransome-Kuti, Sorungbe, Oyegbite & Bamisaiye, 1990).

Patient records management practices include all devices used for recording and processing of significant characteristics of patients and their illnesses to produce a comprehensive data base. Disease surveillance and notification systems involve official report of diseases to designated health authorities, through detection, investigation, reporting and managing cases and out breaks, collecting and compiling data, analyzing and interpreting data, and producing routine information for decision makers, and feed-back for efficient allocation of resources for effective disease epidemic control.

It is therefore assumed that the quality, efficiency, and effectiveness of epidemic control, depends on an evidence-based, and result-oriented disease surveillance and notification systems, that rest on a good patient records management practices, for the generation of accurate and reliable health information for action. Based on this assumption, the researcher examined the relative influence of patient records management practices and disease surveillance and notification systems on disease epidemic control in Local Government Areas of Osun State.

 

1.2.      Statement of the Problem

         An epidemic free environment enhances the health status of all citizens in the community. It has been observed by the investigator as disease surveillance and notification officer in one of the local government areas in Osun State that patient records management practices could affect disease surveillance and notification systems as related to epidemic control in local government areas of Osun State.

This is why Adegbesan (2014) noted that improper management of patient records at the health facility levels hampers the production of accurate and reliable health information for action. Poor response to epidemic control by the concerned authorities usually results from passive disease surveillance and notification systems and improper management of health records generated within the health care facilities which use to have negative impact and grave consequences on epidemic control in the local government areas.

The problem therefore is that it is not clear the extent to which health care professionals in the local government areas pay attention to patient records management practices and disease surveillance and notification systems for effective epidemic control. Therefore, it is important to find out empirically the influence of patient records management practices and disease surveillance and notification systems on effective epidemic control.

It is in the light of this that the study investigated the influence of patient records management practices, disease surveillance and notification systems on epidemic control in local government areas of Osun state; with a view to contributing to finding solutions to problems associated with patient records management practices and disease surveillance and notification systems in relation to epidemic control in local government areas of Osun State.

 

1.3.      Objective of the Study

         The general objective of this study is to investigate the influence of patient records management practices, disease surveillance and notification systems on epidemic control in local government areas of Osun State. The specific objectives are to:

  1. examine the patient records management practices in the local government areas of Osun State;
  2.  ascertain the existing methods of disease surveillance and notification systems in the local government areas of Osun State;
  3.  examine the epidemic control activities in the local government areas of Osun State;
  4.  determine the relationship between patient records management practices and epidemic control in the local government areas of Osun State;
  5.  determine the relationship between patient records management practices and disease surveillance and notification systems in the local government areas of Osun State;
  6.  find out the relationship between disease surveillance and notification systems and epidemic control in the local government areas of Osun State;
  7. assess the joint influence of patient records management practices and disease surveillance and notification systems on epidemic control in the local government areas of Osun State
  8.  determine the relative influence of patient records management practices and disease surveillance and notification systems on epidemic control in the local government areas of Osun State, and
  9.  identify the challenges facing patient records management practices and effective disease surveillance and notification systems in the local government areas of Osun State.

1.4.      Research Questions

In line with the objectives stated above, the study provided answers to the following research questions:

  1. What are the patient records management practices in the local government areas of Osun State?
  2. What are the existing methods of disease surveillance and notification systems in the local government areas of Osun State?
  3. What are the epidemic control activities conducted in the local government areas of Osun State?
  4. What are the challenges facing patient records management practices and disease surveillance and notification systems in the local government areas of Osun State?

1.5.      Hypotheses

The following research hypotheses were tested in this study at 0.05 level of significance:

H01       Patient records management practices have no significant relationship with epidemic control in local government areas of Osun State.

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