Operational characteristics of antiretroviral therapy clinics in Zambia: a time and motion analysis
Abstract Background The 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 wai...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-04-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-019-4096-z |
| _version_ | 1819133859543908352 |
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| author | Radhika P. Tampi Taniya Tembo Mpande Mukumba-Mwenechanya Anjali Sharma David W. Dowdy Charles B. Holmes Carolyn Bolton-Moore Izukanji Sikazwe Austin Tucker Hojoon Sohn |
| author_facet | Radhika P. Tampi Taniya Tembo Mpande Mukumba-Mwenechanya Anjali Sharma David W. Dowdy Charles B. Holmes Carolyn Bolton-Moore Izukanji Sikazwe Austin Tucker Hojoon Sohn |
| author_sort | Radhika P. Tampi |
| collection | DOAJ |
| description | Abstract Background The 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. Methods We 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. Results The percentage of observed clinical time for direct patient interaction (median time per patient encounter) was 43.1% for ART counselors (4 min, interquartile range [IQR] 2–7), 46.1% for nurses (3 min, IQR 2–4), 57.2% for pharmacy technicians (2 min, IQR 1–2), and 78.5% for clinical officers (3 min, IQR 2–5). Patient workloads for HCWs were heaviest between 8 AM and 12 PM with few clinical activities observed after 2 PM. The length of patient visits was inversely associated with arrival time – patients arriving prior to 8 AM spent 61% longer at the clinic than those arriving after 8 AM (277 vs. 171 min). Overall, patients spent 219 min on average for non-clinical visits, and 244 min 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 12 min on average for non-clinical and clinical visits. Conclusion Current 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. |
| first_indexed | 2024-12-22T09:53:59Z |
| format | Article |
| id | doaj.art-1a7b4f844a08416cadb14b566d2b2ade |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-22T09:53:59Z |
| publishDate | 2019-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-1a7b4f844a08416cadb14b566d2b2ade2022-12-21T18:30:18ZengBMCBMC Health Services Research1472-69632019-04-011911810.1186/s12913-019-4096-zOperational characteristics of antiretroviral therapy clinics in Zambia: a time and motion analysisRadhika P. Tampi0Taniya Tembo1Mpande Mukumba-Mwenechanya2Anjali Sharma3David W. Dowdy4Charles B. Holmes5Carolyn Bolton-Moore6Izukanji Sikazwe7Austin Tucker8Hojoon Sohn9Department of Epidemiology, Johns Hopkins Bloomberg School of Public HealthCenters for Infectious Disease Research (CIDRZ)Centers for Infectious Disease Research (CIDRZ)Centers for Infectious Disease Research (CIDRZ)Department of Epidemiology, Johns Hopkins Bloomberg School of Public HealthCenters for Infectious Disease Research (CIDRZ)Centers for Infectious Disease Research (CIDRZ)Centers for Infectious Disease Research (CIDRZ)Department of Epidemiology, Johns Hopkins Bloomberg School of Public HealthDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public HealthAbstract Background The 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. Methods We 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. Results The percentage of observed clinical time for direct patient interaction (median time per patient encounter) was 43.1% for ART counselors (4 min, interquartile range [IQR] 2–7), 46.1% for nurses (3 min, IQR 2–4), 57.2% for pharmacy technicians (2 min, IQR 1–2), and 78.5% for clinical officers (3 min, IQR 2–5). Patient workloads for HCWs were heaviest between 8 AM and 12 PM with few clinical activities observed after 2 PM. The length of patient visits was inversely associated with arrival time – patients arriving prior to 8 AM spent 61% longer at the clinic than those arriving after 8 AM (277 vs. 171 min). Overall, patients spent 219 min on average for non-clinical visits, and 244 min 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 12 min on average for non-clinical and clinical visits. Conclusion Current 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.http://link.springer.com/article/10.1186/s12913-019-4096-zProgram efficiencyTime and motion studiesAntiretroviral therapy care evaluationAntiretroviral therapy program monitoringAllocation of resourcesWorkload |
| spellingShingle | Radhika P. Tampi Taniya Tembo Mpande Mukumba-Mwenechanya Anjali Sharma David W. Dowdy Charles B. Holmes Carolyn Bolton-Moore Izukanji Sikazwe Austin Tucker Hojoon Sohn Operational characteristics of antiretroviral therapy clinics in Zambia: a time and motion analysis BMC Health Services Research Program efficiency Time and motion studies Antiretroviral therapy care evaluation Antiretroviral therapy program monitoring Allocation of resources Workload |
| title | Operational characteristics of antiretroviral therapy clinics in Zambia: a time and motion analysis |
| title_full | Operational characteristics of antiretroviral therapy clinics in Zambia: a time and motion analysis |
| title_fullStr | Operational characteristics of antiretroviral therapy clinics in Zambia: a time and motion analysis |
| title_full_unstemmed | Operational characteristics of antiretroviral therapy clinics in Zambia: a time and motion analysis |
| title_short | Operational characteristics of antiretroviral therapy clinics in Zambia: a time and motion analysis |
| title_sort | operational characteristics of antiretroviral therapy clinics in zambia a time and motion analysis |
| topic | Program efficiency Time and motion studies Antiretroviral therapy care evaluation Antiretroviral therapy program monitoring Allocation of resources Workload |
| url | http://link.springer.com/article/10.1186/s12913-019-4096-z |
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