DREAM Forms

dic type	ctrl type	order	column name	regex	score	formula	description	view condition
Numeric	Text box	1	vn1	^[1-4]$			Session number of EAC
Numeric	Text box	2	vn2	^[0-9]{1,2}$\|100$			Pill count adherence %
String	Linea di divisione	3					Medication Adherence Scale
Boolan (Yes/No)	Select	4	vb1		1		1. Do you ever forget to take your medicine?
Boolan (Yes/No)	Select	5	vb2		1		2. Are you careless at times about taking your medicine?
Boolan (Yes/No)	Select	6	vb3		1		3. Sometimes if you feel worse when you take the medicine, do you stop taking it?
Boolan (Yes/No)	Select	7	vb4		1		4. When you feel better do you sometimes stop taking your medicine?
Boolan (Yes/No)	Select	8	vb5				5. Did you take the medicine yesterday?	vb1\|vb2\|vb3\|vb4
Boolan (Yes/No)	Select	9	vb6				6. When you feel like your symptoms are under control, do you sometimes stop taking your medicine?	vb1\|vb2\|vb3\|vb4
Boolan (Yes/No)	Select	10	vb7				7. Do you ever feel under pressure about sticking to your treatment plan?	vb1\|vb2\|vb3\|vb4
String	Select	11	vt1				8. How often do you have difficulty remembering to take all your medications?	vb1\|vb2\|vb3\|vb4
String	Score Result	12	vt3			=vb1+vb2+vb3+vb4	Medication Adherence Score
String	Score Detail	13	vt2			=vb1+vb2+vb3+vb4	Adherence rating
String	Linea di divisione	14					Understanding Viral Load (High/Suppressed):
Boolan (Yes/No)	Select	15	vb8				Has patient received viral load result?
String	Select	16	vt8				Was the Viral load result suppressed (less than 1000) or unsuppressed (greater than 1000) ?
String	Text box	17	vt9				How does the patient feel concerning the result?
String	Text box	18	vt10				What does the patient think caused the high viral load?
String	Text area	19	vt4				Way forward:
String	Linea di divisione	20					Barriers to adherence - Assess for possible barriers to adherence
String	Linea di divisione	21					Cognitive Barriers
String	Text area	22	vt11				(HIV and ART Knowledge) Assess patient's knowledge about HIV and ART; correct any misconceptions
String	Linea di divisione	23					Behavioural barriers
String	Text area	24	vt12				1. Let the patient explain how they take their drugs, and at what time and how they store them.
String	Text area	25	vt13				2. How does treatment fit the patient daily routines? What reminder tools are used?
String	Text area	26	vt14				3. What does the patient do in case of visits and travels?
String	Text area	27	vt15				4. What does the patient do in case of Side Effects?
String	Text area	28	vt16				5. What are the most difficult situations for the patient to take drugs?
String	Linea di divisione	29					Emotional Barriers
String	Text area	30	vt17				1. How does the patient feel about taking drugs everyday?
String	Text area	31	vt18				2. Motivation. What are the patient ambitions in life? What are the 3 most important things they still want to achieve?
String	Linea di divisione	32					Socio-Economic Barriers
Boolan (Yes/No)	Select	33	vb14				1. Does the patient have any people in their life who they can talk to about HIV status and ART?
String	Text area	34	vt19				2. Discuss how the patient can enlist the support of their family, friends and/or co-workers, a treatment buddy, community or support group?
String	Text area	35	vt20				3. Review the patient's and family's sources of income and how well they cover their needs.
Boolan (Yes/No)	Select	36	vb15				4. Does the patient have any challenges getting the clinic on regular basis?
Boolan (Yes/No)	Select	37	vb16				5. Is the patient worried about people finding out about their HIV status accidentally?
Boolan (Yes/No)	Select	38	vb17				6. Does the patient feel like people treat them differently when they know their HIV status?
Boolan (Yes/No)	Select	39	vb18				7. Is stigma making it difficult for them to take their medications on time, or for them to attend clinical appointments?
Boolan (Yes/No)	Select	40	vb19				8. Find out if the patient has tried faith healing, or if they have ever stopped taking their medicine because of religious belief
String	Linea di divisione	41					Review Adherence Plan from previous session
Boolan (Yes/No)	Select	42	vb9				1. Does patient think adherence has improved since last session?
Boolan (Yes/No)	Select	43	vb10				2. Have any dosses been missed?
String	Text area	44	vt5				3. Review barriers to adherence from previous session and if strategies identified have been taken up, identify other gaps and issue emerging
String	Linea di divisione	45					Referrals and Networks
Boolan (Yes/No)	Select	46	vb11				1. Has the patient been referred to other services? (Nutrition, psychosocial support services, substance use treatment, etc)
Boolan (Yes/No)	Select	47	vb12				2. Did he/she attend the appointments?
String	Text area	48	vt6				3. What was the experience? Do the referrals need to be re-organized?
Boolan (Yes/No)	Select	49	vb13				4. Will the patient benefit from a home visit?
String	Text area	50	vt7				5. Adherence plan

id dictionary	FRM-ENH-ADH
description	Enhanced Adherence Counselling
is single ?
category
linked event
order	25
v. index	10
used
hide in forms
filter hivpos	HIV_YES
filter gender	ALL
filter agemin	0
filter agemax	150

Form fields