Evaluation of the efficiency of patient flow at three HIV clinics in Uganda.
Identifieur interne : 000484 ( PubMed/Corpus ); précédent : 000483; suivant : 000485Evaluation of the efficiency of patient flow at three HIV clinics in Uganda.
Auteurs : Rhoda K. Wanyenze ; Glenn Wagner ; Stella Alamo ; Gideon Amanyire ; Joseph Ouma ; Dalsone Kwarisima ; Pamella Sunday ; Fred Wabwire-Mangen ; Moses KamyaSource :
- AIDS patient care and STDs [ 1557-7449 ] ; 2010.
English descriptors
- KwdEn :
- Ambulatory Care Facilities (organization & administration), Anti-HIV Agents (therapeutic use), Appointments and Schedules, Efficiency, Organizational, HIV Infections (drug therapy), HIV Infections (economics), HIV Infections (prevention & control), Health Care Surveys, Humans, Office Visits (statistics & numerical data), Practice Patterns, Physicians', Quality of Health Care, Time Management, Time and Motion Studies, Uganda.
- MESH :
- chemical , therapeutic use : Anti-HIV Agents.
- geographic : Uganda.
- drug therapy : HIV Infections.
- economics : HIV Infections.
- organization & administration : Ambulatory Care Facilities.
- prevention & control : HIV Infections.
- statistics & numerical data : Office Visits.
- Appointments and Schedules, Efficiency, Organizational, Health Care Surveys, Humans, Practice Patterns, Physicians', Quality of Health Care, Time Management, Time and Motion Studies.
Abstract
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.
DOI: 10.1089/apc.2009.0328
PubMed: 20578908
Links to Exploration step
pubmed:20578908Le document en format XML
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Wanyenze</name><affiliation><nlm:affiliation>Makerere University School of Public Health, Kampala, Uganda. rwanyenze@hotmail.com</nlm:affiliation></affiliation></author><author><name sortKey="Wagner, Glenn" sort="Wagner, Glenn" uniqKey="Wagner G" first="Glenn" last="Wagner">Glenn Wagner</name></author><author><name sortKey="Alamo, Stella" sort="Alamo, Stella" uniqKey="Alamo S" first="Stella" last="Alamo">Stella Alamo</name></author><author><name sortKey="Amanyire, Gideon" sort="Amanyire, Gideon" uniqKey="Amanyire G" first="Gideon" last="Amanyire">Gideon Amanyire</name></author><author><name sortKey="Ouma, Joseph" sort="Ouma, Joseph" uniqKey="Ouma J" first="Joseph" last="Ouma">Joseph Ouma</name></author><author><name sortKey="Kwarisima, Dalsone" sort="Kwarisima, Dalsone" uniqKey="Kwarisima D" first="Dalsone" last="Kwarisima">Dalsone Kwarisima</name></author><author><name sortKey="Sunday, Pamella" sort="Sunday, Pamella" uniqKey="Sunday P" first="Pamella" last="Sunday">Pamella Sunday</name></author><author><name sortKey="Wabwire Mangen, Fred" sort="Wabwire Mangen, Fred" uniqKey="Wabwire Mangen F" first="Fred" last="Wabwire-Mangen">Fred Wabwire-Mangen</name></author><author><name sortKey="Kamya, Moses" sort="Kamya, Moses" uniqKey="Kamya M" first="Moses" last="Kamya">Moses Kamya</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2010">2010</date><idno type="RBID">pubmed:20578908</idno><idno type="pmid">20578908</idno><idno type="doi">10.1089/apc.2009.0328</idno><idno type="wicri:Area/PubMed/Corpus">000484</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000484</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Evaluation of the efficiency of patient flow at three HIV clinics in Uganda.</title><author><name sortKey="Wanyenze, Rhoda K" sort="Wanyenze, Rhoda K" uniqKey="Wanyenze R" first="Rhoda K" last="Wanyenze">Rhoda K. 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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.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">20578908</PMID><DateCreated><Year>2010</Year><Month>07</Month><Day>19</Day></DateCreated><DateCompleted><Year>2010</Year><Month>11</Month><Day>03</Day></DateCompleted><DateRevised><Year>2017</Year><Month>02</Month><Day>20</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1557-7449</ISSN><JournalIssue CitedMedium="Internet"><Volume>24</Volume><Issue>7</Issue><PubDate><Year>2010</Year><Month>Jul</Month></PubDate></JournalIssue><Title>AIDS patient care and STDs</Title><ISOAbbreviation>AIDS Patient Care STDS</ISOAbbreviation></Journal><ArticleTitle>Evaluation of the efficiency of patient flow at three HIV clinics in Uganda.</ArticleTitle><Pagination><MedlinePgn>441-6</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1089/apc.2009.0328</ELocationID><Abstract><AbstractText>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.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Wanyenze</LastName><ForeName>Rhoda K</ForeName><Initials>RK</Initials><AffiliationInfo><Affiliation>Makerere University School of Public Health, Kampala, Uganda. rwanyenze@hotmail.com</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wagner</LastName><ForeName>Glenn</ForeName><Initials>G</Initials></Author><Author ValidYN="Y"><LastName>Alamo</LastName><ForeName>Stella</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Amanyire</LastName><ForeName>Gideon</ForeName><Initials>G</Initials></Author><Author ValidYN="Y"><LastName>Ouma</LastName><ForeName>Joseph</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Kwarisima</LastName><ForeName>Dalsone</ForeName><Initials>D</Initials></Author><Author ValidYN="Y"><LastName>Sunday</LastName><ForeName>Pamella</ForeName><Initials>P</Initials></Author><Author ValidYN="Y"><LastName>Wabwire-Mangen</LastName><ForeName>Fred</ForeName><Initials>F</Initials></Author><Author ValidYN="Y"><LastName>Kamya</LastName><ForeName>Moses</ForeName><Initials>M</Initials></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>R24 HD056651</GrantID><Acronym>HD</Acronym><Agency>NICHD NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>1 R24 HD056651-01</GrantID><Acronym>HD</Acronym><Agency>NICHD NIH HHS</Agency><Country>United States</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D023362">Evaluation Studies</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D052061">Research Support, N.I.H., Extramural</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>AIDS Patient Care STDS</MedlineTA><NlmUniqueID>9607225</NlmUniqueID><ISSNLinking>1087-2914</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D019380">Anti-HIV Agents</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><CitationSubset>X</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="Cites"><RefSource>Perm J. 2008 Summer;12(3):25-34</RefSource><PMID Version="1">21331207</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Hum Resour Health. 2007 May 01;5:12</RefSource><PMID Version="1">17470304</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>AIDS Patient Care STDS. 2008 Mar;22(3):173-4</RefSource><PMID Version="1">18290750</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Int J STD AIDS. 2009 Feb;20(2):123-4</RefSource><PMID Version="1">19182060</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Fam Med. 2001 Jul-Aug;33(7):533-8</RefSource><PMID Version="1">11456246</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>J Med Syst. 2010 Aug;34(4):579-90</RefSource><PMID Version="1">20703912</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Dermatol Surg. 2009 Mar;35(3):437-44; discussion 445</RefSource><PMID Version="1">19292835</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>AIDS Care. 2007 Feb;19(2):149-51</RefSource><PMID Version="1">17364392</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>AIDS Patient Care STDS. 2007 Nov;21(11):871-88</RefSource><PMID Version="1">18240896</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>AIDS. 2008 Nov 12;22(17):2381-90</RefSource><PMID Version="1">18981778</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Med Care. 2007 May;45(5):463-71</RefSource><PMID Version="1">17446833</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>AIDS Patient Care STDS. 2008 Dec;22(12):1007-13</RefSource><PMID Version="1">19072107</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D000554" MajorTopicYN="N">Ambulatory Care Facilities</DescriptorName><QualifierName UI="Q000458" MajorTopicYN="Y">organization & administration</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D019380" MajorTopicYN="N">Anti-HIV Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001071" MajorTopicYN="N">Appointments and Schedules</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017598" MajorTopicYN="Y">Efficiency, Organizational</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015658" MajorTopicYN="N">HIV Infections</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName><QualifierName UI="Q000191" MajorTopicYN="N">economics</QualifierName><QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D019538" MajorTopicYN="N">Health Care Surveys</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009819" MajorTopicYN="N">Office Visits</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D010818" MajorTopicYN="N">Practice Patterns, Physicians'</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011787" MajorTopicYN="N">Quality of Health Care</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017748" MajorTopicYN="N">Time Management</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013996" MajorTopicYN="Y">Time and Motion Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014454" MajorTopicYN="N" Type="Geographic">Uganda</DescriptorName></MeshHeading></MeshHeadingList><OtherID Source="NLM">PMC2933556</OtherID></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2010</Year><Month>6</Month><Day>29</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2010</Year><Month>6</Month><Day>29</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2010</Year><Month>11</Month><Day>4</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">20578908</ArticleId><ArticleId IdType="doi">10.1089/apc.2009.0328</ArticleId><ArticleId IdType="pmc">PMC2933556</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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