Operational characteristics of antiretroviral therapy clinics in Zambia: a time and motion analysis
Operational characteristics of antiretroviral therapy clinics in Zambia: a time and motion analysis
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DOI：
10.1186/s12913-019-4096-z
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发表时间：
2019-04-24
影响因子：
2.8
通讯作者：
Sohn, Hojoon
中科院分区：
文献类型：
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作者：
Tampi, Radhika P.;Tembo, Taniya;Sohn, Hojoon
背景赞比亚大规模扩大抗逆转录病毒疗法（ART）是在基础设施和人力资源有限的情况下进行的，导致许多操作副作用。在这项研究中，我们的目的是经验性地衡量目前的工作量的ART诊所工作人员和病人的等待时间和服务utilization.MethodsWe进行了时间和运动（TAM）的研究，从医护人员（HCW）和病人的角度在10个ART诊所在整个赞比亚。经过培训的人员根据对顾问、临床官员、护士和药房技术人员进行的临床和非临床活动的直接观察，记录连续离散活动的时间。对于患者TAM，我们招募了同意的患者，并记录了到达和离开的时间以及使用的主要ART服务。从10个诊所的数据进行汇总，以评估每名患者花费的每项活动的中位数时间和患者在诊所的停留时间。（每次就诊的中位时间）为43.1%，（4 min，四分位距[IQR] 2-7），护士（3 min，IQR 2-4），药学技术人员（2 min，IQR 1-2），临床人员（3 min，IQR 2-5）分别为46.1%、57.2%和78.5%。HCW的患者工作量在上午8点至下午12点之间最重，下午2点后观察到的临床活动很少。患者就诊时间与到达时间呈负相关-上午8点之前到达的患者在诊所的时间比上午8点之后到达的患者长61%（277分钟vs. 171分钟）。总的来说，患者平均花费219分钟的非临床就诊，244分钟的临床就诊，但这一差异在农村诊所不显着。相比之下，患者直接与诊所工作人员花费的总时间为9和12分钟，平均为非临床和临床visits.ConclusionCurrent赞比亚ART诊所业务包括大量的病人和HCWs的效率低下，工作量严重集中在诊所开放的前几个小时，限制HCW和病人的互动时间。使用差别化护理模式可能有助于在手术时间内重新分配工作量，并防止在诊所开业前等待数小时的患者积压，这可能会大大改善赞比亚的抗逆转录病毒治疗。
BackgroundThe mass scale-up of antiretroviral therapy (ART) in Zambia has taken place in the context of limited infrastructure and human resources resulting in many operational side-effects. In this study, we aimed to empirically measure current workload of ART clinic staff and patient wait times and service utilization.MethodsWe conducted time and motion (TAM) studies from both the healthcare worker (HCW) and patient perspectives at 10 ART clinics throughout Zambia. Trained personnel recorded times for consecutive discrete activities based on direct observation of clinical and non-clinical activities performed by counselors, clinical officers, nurses, and pharmacy technicians. For patient TAM, we recruited consenting patients and recorded times of arrival and departure and major ART services utilized. Data from 10 clinics were pooled to evaluate median time per patient spent for each activity and patient duration of stay in the clinic.ResultsThe percentage of observed clinical time for direct patient interaction (median time per patient encounter) was 43.1% for ART counselors (4min, interquartile range [IQR] 2-7), 46.1% for nurses (3min, IQR 2-4), 57.2% for pharmacy technicians (2min, IQR 1-2), and 78.5% for clinical officers (3min, IQR 2-5). Patient workloads for HCWs were heaviest between 8AM and 12PM with few clinical activities observed after 2PM. The length of patient visits was inversely associated with arrival time - patients arriving prior to 8AM spent 61% longer at the clinic than those arriving after 8AM (277 vs. 171min). Overall, patients spent 219min on average for non-clinical visits, and 244min for clinical visits, but this difference was not significant in rural clinics. In comparison, total time patients spent directly with clinic staff were 9 and 12min on average for non-clinical and clinical visits.ConclusionCurrent Zambian ART clinic operations include substantial inefficiencies for both patients and HCWs, with workloads heavily concentrated in the first few hours of clinic opening, limiting HCW and patient interaction time. Use of a differentiated care model may help to redistribute workloads during operational hours and prevent backlogs of patients waiting for hours before clinic opening, which may substantially improve ART delivery in the Zambian context.