Health care provider time in public primary care facilities in Lima, Peru: a cross-sectional time motion study
Abstract Background In Peru, a majority of individuals bypass primary care facilities even for routine services. Efforts to strengthen primary care must be informed by understanding of current practice. We conducted a time motion assessment in primary care facilities in Lima with the goals of assess...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-02-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-021-06117-9 |
| _version_ | 1831700881444175872 |
|---|---|
| author | Hannah H. Leslie Denisse Laos Cesar Cárcamo Ricardo Pérez-Cuevas Patricia J. García |
| author_facet | Hannah H. Leslie Denisse Laos Cesar Cárcamo Ricardo Pérez-Cuevas Patricia J. García |
| author_sort | Hannah H. Leslie |
| collection | DOAJ |
| description | Abstract Background In Peru, a majority of individuals bypass primary care facilities even for routine services. Efforts to strengthen primary care must be informed by understanding of current practice. We conducted a time motion assessment in primary care facilities in Lima with the goals of assessing the feasibility of this method in an urban health care setting in Latin America and of providing policy makers with empirical evidence on the use of health care provider time in primary care. Methods This cross-sectional continuous observation time motion study took place from July – September 2019. We used two-stage sampling to draw a sample of shifts for doctors, nurses, and midwives in primary health facilities and applied the Work Observation Method by Activity Timing tool to capture type and duration of provider activities over a 6-h shift. We summarized time spent on patient care, paper and electronic record-keeping, and non-work (personal and inactive) activities across provider cadres. Observations are weighted by inverse probability of selection. Results Two hundred seventy-five providers were sampled from 60 facilities; 20% could not be observed due to provider absence (2% schedule error, 8% schedule change, 10% failure to appear). One hundred seventy-four of the 220 identified providers consented (79.1%) and were observed for a total of 898 h of provider time comprising 30,312 unique tasks. Outpatient shifts included substantial time on patient interaction (110, 82, and 130 min for doctors, nurses, and midwives respectively) and on paper records (132, 97, and 141 min) on average. Across all shifts, 1 in 6 h was spent inactive or on personal activities. Two thirds of midwives used computers compared to half of nurses and one third of doctors. Conclusions The time motion study is a feasible method to capture primary care operations in Latin American countries and inform health system strengthening. In the case of Lima, absenteeism undermines health worker availability in primary care facilities, and inactive time further erodes health workforce availability. Productive time is divided between patient-facing activities and a substantial burden of paper-based record keeping for clinical and administrative purposes. Electronic health records remain incompletely integrated within routine care, particularly beyond midwifery. |
| first_indexed | 2024-12-20T14:48:29Z |
| format | Article |
| id | doaj.art-ff25938cd866474db3d7c65a29e8b388 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-20T14:48:29Z |
| publishDate | 2021-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-ff25938cd866474db3d7c65a29e8b3882022-12-21T19:37:03ZengBMCBMC Health Services Research1472-69632021-02-0121111110.1186/s12913-021-06117-9Health care provider time in public primary care facilities in Lima, Peru: a cross-sectional time motion studyHannah H. Leslie0Denisse Laos1Cesar Cárcamo2Ricardo Pérez-Cuevas3Patricia J. García4Department of Global Health and Population, Harvard TH Chan School of Public HealthSchool of Public Health, Universidad Peruana Cayetano HerediaSchool of Public Health, Universidad Peruana Cayetano HerediaDivision of Social Protection and Health, Jamaica Country Office, Inter-American Development BankSchool of Public Health, Universidad Peruana Cayetano HerediaAbstract Background In Peru, a majority of individuals bypass primary care facilities even for routine services. Efforts to strengthen primary care must be informed by understanding of current practice. We conducted a time motion assessment in primary care facilities in Lima with the goals of assessing the feasibility of this method in an urban health care setting in Latin America and of providing policy makers with empirical evidence on the use of health care provider time in primary care. Methods This cross-sectional continuous observation time motion study took place from July – September 2019. We used two-stage sampling to draw a sample of shifts for doctors, nurses, and midwives in primary health facilities and applied the Work Observation Method by Activity Timing tool to capture type and duration of provider activities over a 6-h shift. We summarized time spent on patient care, paper and electronic record-keeping, and non-work (personal and inactive) activities across provider cadres. Observations are weighted by inverse probability of selection. Results Two hundred seventy-five providers were sampled from 60 facilities; 20% could not be observed due to provider absence (2% schedule error, 8% schedule change, 10% failure to appear). One hundred seventy-four of the 220 identified providers consented (79.1%) and were observed for a total of 898 h of provider time comprising 30,312 unique tasks. Outpatient shifts included substantial time on patient interaction (110, 82, and 130 min for doctors, nurses, and midwives respectively) and on paper records (132, 97, and 141 min) on average. Across all shifts, 1 in 6 h was spent inactive or on personal activities. Two thirds of midwives used computers compared to half of nurses and one third of doctors. Conclusions The time motion study is a feasible method to capture primary care operations in Latin American countries and inform health system strengthening. In the case of Lima, absenteeism undermines health worker availability in primary care facilities, and inactive time further erodes health workforce availability. Productive time is divided between patient-facing activities and a substantial burden of paper-based record keeping for clinical and administrative purposes. Electronic health records remain incompletely integrated within routine care, particularly beyond midwifery.https://doi.org/10.1186/s12913-021-06117-9PeruPrimary health careAbsenteeismTime motionHealth information systems |
| spellingShingle | Hannah H. Leslie Denisse Laos Cesar Cárcamo Ricardo Pérez-Cuevas Patricia J. García Health care provider time in public primary care facilities in Lima, Peru: a cross-sectional time motion study BMC Health Services Research Peru Primary health care Absenteeism Time motion Health information systems |
| title | Health care provider time in public primary care facilities in Lima, Peru: a cross-sectional time motion study |
| title_full | Health care provider time in public primary care facilities in Lima, Peru: a cross-sectional time motion study |
| title_fullStr | Health care provider time in public primary care facilities in Lima, Peru: a cross-sectional time motion study |
| title_full_unstemmed | Health care provider time in public primary care facilities in Lima, Peru: a cross-sectional time motion study |
| title_short | Health care provider time in public primary care facilities in Lima, Peru: a cross-sectional time motion study |
| title_sort | health care provider time in public primary care facilities in lima peru a cross sectional time motion study |
| topic | Peru Primary health care Absenteeism Time motion Health information systems |
| url | https://doi.org/10.1186/s12913-021-06117-9 |
| work_keys_str_mv | AT hannahhleslie healthcareprovidertimeinpublicprimarycarefacilitiesinlimaperuacrosssectionaltimemotionstudy AT denisselaos healthcareprovidertimeinpublicprimarycarefacilitiesinlimaperuacrosssectionaltimemotionstudy AT cesarcarcamo healthcareprovidertimeinpublicprimarycarefacilitiesinlimaperuacrosssectionaltimemotionstudy AT ricardoperezcuevas healthcareprovidertimeinpublicprimarycarefacilitiesinlimaperuacrosssectionaltimemotionstudy AT patriciajgarcia healthcareprovidertimeinpublicprimarycarefacilitiesinlimaperuacrosssectionaltimemotionstudy |