Kwena Zachary A, Njoroge Betty W, Cohen Craig R, Oyaro Patrick, Shikari Rosemary, Kibaara Charles K, Bukusi Elizabeth A
Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya;
Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya.
J Int AIDS Soc. 2015 Jul 9;18(1):19876. doi: 10.7448/IAS.18.1.19876. eCollection 2015.
As efforts are made to reach universal access to ART in Kenya, the problem of congestion at HIV care clinics is likely to worsen. We evaluated the feasibility and the economic benefits of a designated time appointment system as a solution to decongest HIV care clinics.
This was an explanatory two-arm open-label randomized controlled trial that enrolled 354 consenting participants during their normal clinic days and followed-up at subsequent clinic appointments for up to nine months. Intervention arm participants were given specific dates and times to arrive at the clinic for their next appointment while those in the control arm were only given the date and had the discretion to decide on the time to arrive as is the standard practice. At follow-up visits, we recorded arrival and departure times and asked the monetary value of work participants engaged in before and after clinic. We conducted multiple imputation to replace missing data in our primary outcome variables to allow for intention-to-treat analysis; and analyzed the data using Mann-Whitney U test.
Overall, 72.1% of the intervention participants arrived on time, 13.3% arrived ahead of time and 14.6% arrived past scheduled time. Intervention arm participants spent a median of 65 [interquartile range (IQR), 52-87] minutes at the clinic compared to 197 (IQR, 173-225) minutes for control participants (p<0.01). Furthermore, intervention arm participants were more productively engaged on their clinic days valuing their cumulative work at a median of USD 10.5 (IQR, 60.0-16.8) compared to participants enrolled in the control arm who valued their work at USD 8.3 (IQR, 5.5-12.9; p=0.02).
A designated time appointment system is feasible and provides substantial time savings associated with greater economic productivity for HIV patients attending a busy HIV care clinic.
随着肯尼亚努力实现抗逆转录病毒治疗（ART）的普遍可及，艾滋病毒护理诊所拥堵的问题可能会恶化。我们评估了指定时间预约系统作为缓解艾滋病毒护理诊所拥堵问题的解决方案的可行性和经济效益。
这是一项解释性双臂开放标签随机对照试验，在正常门诊日招募了354名同意参与的参与者，并在随后的门诊预约中进行了长达九个月的随访。干预组参与者被告知下次就诊到达诊所的具体日期和时间，而对照组参与者只被告知日期，可自行决定到达时间，这是标准做法。在随访就诊时，我们记录了到达和离开时间，并询问参与者就诊前后从事工作的货币价值。我们进行了多次插补以替换主要结局变量中的缺失数据，以便进行意向性分析；并使用曼-惠特尼U检验分析数据。
总体而言，72.1%的干预组参与者按时到达，13.3%提前到达，14.6%迟到。干预组参与者在诊所的中位停留时间为65分钟[四分位间距（IQR），52 - 87]，而对照组参与者为197分钟（IQR，第173 - 225）（p<0.01）。此外，干预组参与者在就诊日的工作效率更高，其累计工作价值的中位数为10.5美元（IQR，6.0 - 16.8），而对照组参与者的工作价值为8.3美元（IQR，5.5 - 12.9；p = 0.02）。
指定时间预约系统是可行的，对于在繁忙的艾滋病毒护理诊所就诊的艾滋病毒患者而言，该系统可大幅节省时间，并提高经济效益。
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