Maximizing utilization of existing staff time at two HIV treatment
sites in Jamaica
Presented by Fiona Walsh (United States).
F. Walsh1, M. Aung2, J. Lowe3, M. Clarke2, E. McCarthy1
1Clinton Health Access Initiative, Center for Strategic Health Operations Research, Boston, United States, 2Ministry of Health - Jamaica, Western Region Health Authority, Montego Bay, Jamaica, 3Clinton Health Access Initiative, CHAI Jamaica, Kingston, Jamaica
Background: As the number of HIV-positive patients in care and treatment expands,
identifying opportunities to maximize the utilization of existing human and
financial resources while also maintaining high quality care is critical.
At two hospitals in the western region of Jamaica, the long wait time
for physicians was identified as a significant bottleneck.
Methods: Randomly selected patients were followed each clinic
day to collect data on wait times and time spent with clinical staff. Over six
weeks, 535 observations of patient visits with physicians and 366 observations
of patient visits with nurses were collected. Two visit schedules for HIV patients were modeled
- one reflecting the current practice in the clinics where all HIV patients
return every month to see the physician, and the second created as a
hypothetical scenario where patients on treatment for more than 6 months would
return every 3 months for clinical follow-up with a physician and for refill
visits with nurses in between. The nurses would screen patients at intake for
Results: On average, patients wait 3 hours in the clinic for an
11 minute visit with a physician. Shifting from the current visit schedule to
the revised schedule would give physicians an additional 2 hours, 28 minutes each
clinic day (a 19% increase in physician time) (Figure 1).
[Figure 1. Physician and Nurse Time Saved]
Conclusions: The suggested approach would increase available physician time for
patient visits and follow-up by more than two hours each day, freeing their
time to see additional patients. These recommendations are currently under
consideration in Jamaica.
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