Olwanda Easter, Shen Jennifer, Kahn James G, Bryant-Comstock Katelyn, Huchko Megan J
a Center for Microbiology Research , Kenya Medical Research Institute , Nairobi , Kenya.
b Institute for Health Policy Studies , University of California , San Francisco , CA , USA.
Glob Health Action. 2018;11(1):1451455. doi: 10.1080/16549716.2018.1451455.
Improving patient flow and reducing over-crowding can improve quality, promptness of care, and patient satisfaction. Given low utilization of preventive care in low-resource countries, improved patient flows are especially important in these settings.
Compare patient flow and provider efficiency between two cervical cancer screening strategies via self-collected human papillomavirus (HPV).
We collected time and motion data for patients screened for cervical cancer in 12 communities in rural Migori County, Kenya as part of a larger cluster randomized trial. Six communities were randomized to screening in community health campaigns (CHCs) and six to screening at government clinics. We quantified patient flow: duration spent on each active stage of screening and wait times, and the number of patients arriving at CHCs and clinics each hour of the day. In addition, for four CHCs, we collected time and motion data for providers, and measured provider efficiency as a ratio of active (service delivery) time to total time spent at the clinic.
Total duration of screening visits, at CHCs and clinics was 42 and 87 minutes, respectively (p < 0.001 for difference). Total active time lasted longer at CHCs, with a mean of 28 minutes per patient versus 15 minutes at clinics, largely due to differences in duration for group education (p < 0.001). Wait time for registration at clinics was 36 minutes, explaining most of the difference between settings, but sometimes incorporated other health services.
There is a substantial difference in patient flow at clinics compared to CHCs. Shorter duration at CHCs suggests that the model is favorable for patients in limiting time spent on screening. Future cervical cancer screening programs designed for scale-up should consider how this advantage may enhance satisfaction and uptake. For clinic-based screening programs, efforts could be made towards reducing registration wait times.
改善患者流程并减少过度拥挤可提高医疗质量、及时性以及患者满意度。鉴于资源匮乏国家预防性医疗服务的利用率较低，在这些环境中改善患者流程尤为重要。
比较两种通过自我采集人乳头瘤病毒（HPV）进行宫颈癌筛查策略的患者流程及医疗服务提供者的效率。
作为一项更大规模整群随机试验的一部分，我们收集了肯尼亚米戈里县农村12个社区宫颈癌筛查患者的时间和行动数据。六个社区被随机分配到社区健康活动（CHC）中进行筛查，另外六个社区在政府诊所进行筛查。我们对患者流程进行了量化：筛查每个活跃阶段所花费的时间、等待时间，以及每天各小时到达CHC和诊所的患者数量。此外，对于四个CHC，我们收集了医疗服务提供者的时间和行动数据，并将医疗服务提供者的效率衡量为在诊所的活跃（服务提供）时间与总时间的比率。
CHC和诊所筛查就诊的总时长分别为42分钟和87分钟（差异p<0.001）。CHC的总活跃时间更长，每位患者平均为28分钟，而诊所为15分钟，这主要是由于群体教育时长的差异（p<0.001）。诊所的登记等待时间为36分钟，这解释了不同环境之间的大部分差异，但有时还包括其他医疗服务。
与CHC相比，诊所的患者流程存在显著差异。CHC的时长较短表明该模式有利于患者限制筛查所花费的时间。未来为扩大规模而设计的宫颈癌筛查项目应考虑这一优势如何提高满意度和接受度。对于基于诊所的筛查项目，可以努力减少登记等待时间。
