Evaluation of the Efficiency of Patient Flow at Three HIV Clinics in Uganda
Evaluation of the Efficiency of Patient Flow at Three HIV Clinics in Uganda
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DOI：
10.1089/apc.2009.0328
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发表时间：
2010-07-01
影响因子：
4.9
通讯作者：
Kamya, Moses
中科院分区：
文献类型：
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作者：
Wanyenze, Rhoda K.;Wagner, Glenn;Kamya, Moses
随着抗逆转录病毒疗法(ART)的提供急剧增加，撒哈拉以南非洲的许多诊所都很拥挤，但很少有人关注诊所的效率。2008年4月至6月，我们进行了一项时间和行动研究，以评估乌干达三家艾滋病毒诊所的病人流动情况。穆拉戈艾滋病毒诊所有6700名活跃患者，相比之下，姆巴拉市议会诊所(MMC)有2700名活跃患者，Reachout Mbuya(ROM)有2800名。穆拉戈有六名医生和八名护士；MMC有两名医生和两名护士，罗曼有两名医生和12名护士。穆拉戈和MMC使用医生主导的模式，而罗曼使用护士主导的模式。随机选择的患者被跟踪，收集了等待时间和与提供者相处的时间的数据。患者被分为新发、准备接受抗逆转录病毒治疗、早期抗逆转录病毒治疗、稳定抗逆转录病毒治疗或非抗逆转录病毒治疗。医生们表示，他们看到的病人是否值得咨询。收集了689名患者的数据(穆拉戈230名，MMC 229名，ROM230名)。与MMC(183分钟；148-233)相比，只读存储器(274分钟；209-346)和穆拉戈国际空间站(270分钟；230-336)的总等待时间最长。与穆拉戈的医生相比，罗曼医院的护士-临床医生花在病人身上的时间是前者的两倍。在穆拉戈，医生表示，他们审查的患者中有27%不需要看医生，而在MMC，这一比例为45%。就时间而言，任务转移可能效率不高。更有效的分诊和更长的就诊间隔可以改善患者流量，并提高成本效益扩大的能力。
With dramatic increases in antiretroviral therapy (ART) provision, many clinics in sub-Saharan Africa are congested, but little attention has focused on the efficiency of clinics. Between April and June 2008, we conducted a time-and-motion study to assess patient flow at three HIV clinics in Uganda. Mulago HIV Clinic had 6,700 active patients, compared with 2,700 at Mbarara Municipal Council Clinic (MMC) and 2,800 at Reachout Mbuya (ROM). Mulago had six doctors and eight nurses; MMC had two doctors and two nurses, and ROM had two doctors and 12 nurses. Mulago and MMC used a doctor-led model, whereas ROM used a nurse-led model. Randomly selected patients were tracked, with data collected on time waiting and time spent with providers. Patients were categorized as new, preparing for ART, early ART, stable ART, or non-ART. Doctors indicated whether the patients they saw warranted their consultation. Data were collected on 689 patients (230 at Mulago, 229 at MMC, and 230 at ROM). Overall waiting time was longest at ROM (274 min; 209-346) and Mulago ISS (270 min; 230-336) compared with MMC (183 min; 148-233). Nurse-clinicians at ROM spent twice the time with patients compared with the doctors at Mulago. At Mulago, doctors indicated that 27% of the patients they reviewed did not need to see a doctor, compared with 45% at MMC. Task-shifting may not be efficient in terms of time. More-effective triage and longer visit intervals could improve patient flow and capacity for cost-effective scale-up.