Evaluation of the efficiency of patient flow at three HIV clinics in Uganda
AIDS Patient Care and STDs
Makerere University, School of Public Health, P.O. Box 7072, Kampala, Uganda; RAND Corporation, Santa Monica, CA, United States; Reachout Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda; Mulago-Mbarara Teaching Hospitals' Joint AIDS Program, Kampala, Uganda; Makerere University, School of Medicine, Kampala, Uganda
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. © 2010, Mary Ann Liebert, Inc. 2010.
Africa; article; clinical effectiveness; consultation; controlled study; cost effectiveness analysis; emergency health service; female; health care personnel; human; Human immunodeficiency virus infected patient; information processing; major clinical study; male; nurse; outpatient department; patient care; patient selection; physician; Uganda; virotherapy; ambulatory care; clinical practice; economics; evaluation study; health care quality; health care survey; HIV Infections; hospital management; organization and management; outpatient department; statistics and numerical data; task performance; time management; Uganda; anti human immunodeficiency virus agent; Ambulatory Care Facilities; Anti-HIV Agents; Appointments and Schedules; Efficiency, Organizational; Health Care Surveys; HIV Infections; Humans; Office Visits; Physician's Practice Patterns; Quality of Health Care; Time and Motion Studies; Time Management; Uganda