Abstract

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. McCarthy<sup>1

1</sup>Clinton 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 complications.
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.