Leslie Hannah H, Laos Denisse, Cárcamo Cesar, Pérez-Cuevas Ricardo, García Patricia J
Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA.
School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru.
BMC Health Serv Res. 2021 Feb 6;21(1):123. doi: 10.1186/s12913-021-06117-9.
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.
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.
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.
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.
在秘鲁，大多数人即使是进行常规服务也会绕过初级保健机构。加强初级保健的努力必须基于对当前实践的了解。我们在利马的初级保健机构进行了一项时间动作评估，目的是评估这种方法在拉丁美洲城市卫生保健环境中的可行性，并为政策制定者提供关于初级保健中医疗服务提供者时间使用情况的实证证据。
这项横断面连续观察时间动作研究于2019年7月至9月进行。我们采用两阶段抽样方法，抽取初级卫生保健机构中医生、护士和助产士的班次样本，并应用活动计时工作观察方法工具，记录医疗服务提供者在6小时班次内的活动类型和持续时间。我们总结了不同医疗服务提供者类别在患者护理、纸质和电子记录保存以及非工作（个人和非活动）活动上花费的时间。观察结果通过选择的逆概率进行加权。
从60个机构中抽取了275名医疗服务提供者；由于提供者缺勤，20%的人无法被观察到（2%是排班错误，8%是排班变更，10%是未出现）。在220名被识别的医疗服务提供者中，174名同意参与（79.1%），共观察到898小时的医疗服务提供者时间，包括30312项独特任务。门诊班次平均在患者互动上花费大量时间（医生、护士和助产士分别为110分钟、82分钟和130分钟），在纸质记录上花费的时间也较多（分别为132分钟、97分钟和141分钟）。在所有班次中，每6小时就有1小时用于非活动或个人活动。三分之二的助产士使用电脑，而护士和医生使用电脑的比例分别为一半和三分之一。
时间动作研究是一种可行的方法，可用于了解拉丁美洲国家的初级保健运作情况，并为卫生系统加强提供信息。就利马而言，旷工现象削弱了初级保健机构中卫生工作者的可及性，非活动时间进一步侵蚀了卫生人力的可及性。生产时间在面向患者的活动和大量用于临床及行政目的的纸质记录保存负担之间分配。电子健康记录在常规护理中仍未完全整合，尤其是在助产工作之外。
