Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
Programme of Bio & Research Ethics and Medical Law, Nelson R Mandela School of Medicine & School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
PLoS One. 2024 Aug 21;19(8):e0299253. doi: 10.1371/journal.pone.0299253. eCollection 2024.
Globally, reduction of patient waiting time has been identified as one of the major characteristics of a functional health system. In South Africa, 83% of the general population visiting primary healthcare (PHC) facilities must contend with long waiting times, overcrowding, staff shortages, poor quality of care, an ineffective appointment booking system, and a lack of medication. These experiences may, in turn, affect how patients view service quality.
This scoping review was guided by Arksey and O'Malley methodological framework. The primary literature search of peer-reviewed and review articles was achieved through PubMed/MEDLINE, Google Scholar, Science Direct, and World Health Organization (WHO) library databases, using waiting times, outpatient departments, factors, interventions, and primary healthcare facilities as keywords. Two independent reviewers screened abstracts and full articles, using the set inclusion and exclusion criteria. We used NVIVO® version 10 software to facilitate thematic analysis of the results from included studies.
From the initial 250 records screened, nine studies were eligible for inclusion in this scoping review. Seven papers identified the factors contributing to waiting time, and five papers mentioned effective interventions implemented to reduce waiting times within PHC facilities. Our analysis produced three (patient factors, staff factors, and administrative systems) and two (manual-based waiting time reduction systems and electronic-based waiting time reduction systems) main themes pertaining to factors contributing to long waiting times and interventions to reduce waiting times, respectively.
Our results revealed that the patients, staff, and administrative systems all contribute to long waiting times within the PHC facilities. Patient waiting times recorded a wider and more evenly spread patient arrival pattern after the identified interventions in our study were implemented. There is a need to constantly strategize on measures such as implementing the use of an electronic appointment scheduling system and database, improving staff training on efficient patient flow management, and regularly assessing and optimizing administrative processes. By continuously monitoring and adapting these strategies, PHC facility managers can create a more efficient and patient-centered healthcare experience.
在全球范围内，减少患者的等候时间已被确定为功能健全的卫生系统的主要特征之一。在南非，83%的到基层医疗保健（PHC）机构就诊的普通民众都必须面对长时间的等候、过度拥挤、人员短缺、护理质量差、预约系统效率低下以及缺乏药物等问题。这些经历可能会反过来影响患者对服务质量的看法。
本研究采用 Arksey 和 O'Malley 的方法学框架进行了范围综述。通过 PubMed/MEDLINE、Google Scholar、Science Direct 和世界卫生组织（WHO）图书馆数据库，使用等候时间、门诊部、因素、干预措施和基层医疗保健设施等关键词对同行评议文章和综述文章进行了初步文献检索。两名独立评审员使用设定的纳入和排除标准筛选摘要和全文。我们使用 NVIVO® 版本 10 软件对纳入研究的结果进行主题分析。
在最初筛选的 250 条记录中，有 9 项研究符合本范围综述的纳入标准。有 7 篇论文确定了导致等候时间延长的因素，5 篇论文提到了在 PHC 设施内实施的有效干预措施以减少等候时间。我们的分析产生了三个（患者因素、工作人员因素和行政系统）和两个（基于手动的等候时间减少系统和基于电子的等候时间减少系统）主题，分别涉及导致长时间等候的因素和减少等候时间的干预措施。
我们的研究结果表明，患者、工作人员和行政系统都会导致 PHC 设施内的长时间等候。在实施我们研究中确定的干预措施后，记录的患者等候时间呈现出更广泛和更均匀的患者到达模式。需要不断制定策略，例如实施电子预约调度系统和数据库的使用，加强工作人员在有效患者流程管理方面的培训，以及定期评估和优化行政流程。通过不断监测和调整这些策略，PHC 设施管理人员可以创造更高效和以患者为中心的医疗保健体验。
