Health care provider time in public primary care facilities in Lima, Peru: a cross-sectional time motion study

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa

“…The planned electronic recordkeeping process could improve this, if it is rolled out. 53 Different resources should also be linked so that time can be saved looking for results and referral forms.…”

Evaluating patient-reported outcome measures in Peru: a cross-sectional study of satisfaction and net promoter score using the 2016 EnSuSalud survey

“…The private sector is financed by private insurance or out-of-pocket payment 22. As of 2015 when the patient satisfaction surveys were being conducted regularly, 37% of the population was covered by MoH, 21% by EsSalud, 3% within armed forces and 5.5% with private insurance, leaving just over 37% without insurance23; public insurance coverage has since been expanded 8…”

“…7 Peru is a middle-income country of over 32 million people that, prior to the COVID-19 pandemic, experienced substantial gains in life expectancy despite a health workforce shortage and increasing burden of non-communicable diseases. 8 The government of Peru conducted surveys of patient experience and user satisfaction with outpatient care from 2014 to 2016. Analyses of these data have identified generally high satisfaction, with lower satisfaction in individuals waiting longer for care or experiencing shorter consultations.…”

“…Peru is a middle-income country of over 32 million people that, prior to the COVID-19 pandemic, experienced substantial gains in life expectancy despite a health workforce shortage and increasing burden of non-communicable diseases. 8 The government of Peru conducted surveys of patient experience and user satisfaction with outpatient care from 2014 to 2016. Analyses of these data have identified generally high satisfaction, with lower satisfaction in individuals waiting longer for care or experiencing shorter consultations.…”

Waktu Kontak Petugas Dengan Pasien Terhadap Kualitas Layanan: Studi Perspektif Petugas Kesehatan Di Puskesmas X

“…47-48 Cilandak Jakarta Selatan, Indonesia email: jurnalquality@poltekkesjakarta1.ac.id kesehatan menghadapi tuntutan pekerjaan yang menyita banyak waktu mereka. Meningkatnya prosedur administrasi untuk layanan perawatan kesehatan (misalnya persyaratan layanan dan otorisasi, proses tinjauan utilisasi, dan lain sebagainya) mengalihkan banyak waktu berkualitas yang seyogyanya digunakan untuk berinteraksi dengan pasien sebagaimana dilaporkan juga dalam penelitian di Peru (Leslie et al, 2021). Para dokter cenderung menjadi kurang menggali pertanyaan tentang gejala utama pasien, kurang detail dalam memeriksa pasien, dan tidak memberikan nasihat yang adekuat kepada pasien karena keterbatasan waktu (Tsiga et al, 2013).…”