Patterns of care in two HIV continuity clinics in Uganda, Africa: a time-motion study.
Patterns of care in two HIV continuity clinics in Uganda, Africa: a time-motion study.
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非洲乌干达两个艾滋病毒连续性诊所的护理模式：时间运动研究。
DOI：
10.1080/09540120701687067
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发表时间：
2008
期刊：
影响因子：
1.7
通讯作者：
Tierney,WM
中科院分区：
文献类型：
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作者：
Were,MC;Sutherland,JM;Bwana,M;Ssali,J;Emenyonu,N;Tierney,WM
该研究的目的是通过检查乌干达两个大型艾滋病毒门诊诊所的工作流程和患者活动，确定在资源有限的环境中提高护理质量的机会。利用时间运动研究技术，我们收集了乌干达两个政府资助的艾滋病诊所的患者和临床医生的所有活动的详细数据。测量的过程包括临床医生（医生，执业护士和临床官员）在诊所花费的时间，每日患者普查和患者就诊时间。我们还记录了提供者和患者在各种活动上花费的时间。我们发现，在马萨卡，每个工作日的平均门诊时间为5.5小时，在姆巴拉拉为4.9小时，其中约60%的时间用于两个地点的患者的直接和间接护理。工作日的开始时间在马萨卡相差两个小时，在姆巴拉拉相差一个半小时，结束时间分别相差五小时和三小时。每天有119名患者（SD 34）访问马萨卡，107名患者（SD 45）访问姆巴拉拉。马萨卡和姆巴拉拉的患者平均就诊时间分别为77分钟和196分钟，分别有66%和62%的时间在各自的站点等待护理。我们的结论是，在资源匮乏的环境中，临床医生在诊所现场花费的时间有限，大部分的临床时间被不需要专门的病人护理技能的任务所占用。这项研究表明，存在机会，以提高诊所的生产力和访问的病人的经验，并提供了一个基线设计和评估的影响，过程改进干预措施。
The study objectives were to identify opportunities to improve the quality of care in resource-limited settings by examining the workflow and patient activities at two large outpatient HIV clinics in Uganda. Using time motion study techniques, we collected detailed data on all activities of patients and clinicians in two government-sponsored HIV clinics in Uganda. Processes measured included amount of time clinicians (physicians, nurse practitioners and clinical officers) spend in clinic, the daily patient census and patient visit-length. We also recorded the time spent on various activities by providers and patients. We found that the mean time in clinic per workday at Masaka was 5.5 hours and at Mbarara 4.9 hours, with about 60% of this time spent in direct and indirect care of patients at both sites. Workday start-times varied by two hours in Masaka and one-and-a half hours in Mbarara and end-times by five and three hours respectively. One-hundred-and-nineteen patients (SD 34) visited Masaka each day and 107 (SD 45) visited Mbarara. The mean duration of the patient visit was 77 minutes at Masaka and 196 minutes at Mbarara, with 66% and 62% of the time spent at respective sites waiting for care. We conclude that clinicians in resource-poor settings spend limited amounts of time at the clinic site, with a large portion of the clinic-time taken up by tasks that do not require specialized patient-care skills. This study demonstrates that opportunities exist to improve clinic productivity and visit experience for patients, and provides a baseline for designing and evaluating the impact of process improvement interventions.