The role of triage to reduce waiting times in primary health care facilities in the North West province of South Africa

Swart, Anna-Therese; Muller, Catherina E.; Rabie, Tinda

doi:10.4102/hsag.v23i0.1097

Cited by 10 publications

(7 citation statements)

References 17 publications

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“…Furthermore, limited access to affordable healthcare services is an important contributor to late ANC presentation in African countries [18]. Even in South Africa, where patients are no more than a ten minute walking distance from a Primary Health Care Centre (PHC), long waiting periods, overcrowding and limited health personnel continue to challenge the provision of quality health services [19, 20]. Ebonwu et al (2018) found that late ANC presentation in rural South Africa was associated with being married, employed, less than 20 years of age, having an unplanned pregnancy and being pregnant for the first time [18].…”

Section: Introductionmentioning

confidence: 99%

Reasons for late presentation for antenatal care, healthcare providers’ perspective

Jinga

Mongwenyana

Moolla

et al. 2019

BMC Health Serv Res

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BackgroundAntenatal care (ANC) provides healthcare services to pregnant women in an attempt to ensure, the best possible pregnancy outcome for women and their babies. Healthcare providers’ understanding of their patient’s behaviour and reasons for engagement in care and their response to this insight can influence patient-provider interactions and patient demand for ANC early in pregnancy. We examined the insight of healthcare providers into women’s reasons for starting ANC later than the South African National Department of Health’s recommended 20 weeks gestation. We also looked at the impact of late ANC presentation on overall healthcare providers’ work experiences and their response in their interactions with patients.MethodsIn-depth interviews were conducted with 10 healthcare providers at Maternal Obstetrics Units (MOU) and Primary Healthcare Centres (PHC) in Gauteng, South Africa. Healthcare providers were selected with the assistance of the facility managers. Data analysis was conducted using the qualitative analysis software NVivo 11, using a thematic approach of pinpointing, examining, and recording patterns within the data.ResultsHealthcare providers were aware of patients need for secrecy in the early stages of pregnancy because of fears of miscarriage and women’s preference for traditional care. Women with prior pregnancies presumed to know about stages of pregnancy and neglected to initiate ANC early. Barriers to early ANC initiation also include, women’s need to balance income generating activities; travel cost to the clinic and refusal of care for coming after the daily patient limit has been reached. Healthcare providers encounter negative attitudes from un-booked patients. This has a reciprocal effect whereby this experience impacts on whether healthcare providers will react with empathy or frustration.ConclusionsTiming of ANC is influenced by the complex decisions women make during pregnancy, starting from accepting the pregnancy itself to acknowledging the need for ANC. To positively influence this decision making for the benefit of early ANC, barriers such as lack of knowledge should be addressed prior to pregnancy through awareness programmes. The relationship between healthcare providers and women should be emphasized when training healthcare providers and considered as an important factor that can affect the timing of ANC.

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Section: Introductionmentioning

confidence: 99%

Reasons for late presentation for antenatal care, healthcare providers’ perspective

Jinga

Mongwenyana

Moolla

et al. 2019

BMC Health Serv Res

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“…Women usually delayed presenting to the clinic not only because of home management, but because of protracted clinic waiting times and bottle necks (Egbujie et al, 2018;Sastry et al, 2015;Stime et al, 2018;Swart et al, 2018). As many women explained, it seemed pointless to present to the clinic and wait for some hours, with no resolution at the end of the day: "You'd rather try helping yourself at home, rather than coming to the clinic".…”

Section: Methodsmentioning

confidence: 99%

Prescribing, care and resistance: antibiotic use in urban South Africa

Manderson

2020

Humanit Soc Sci Commun

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patients' and providers' expectations of transactions in health services converge in consultations for acute respiratory tract infections with the prescription of antibiotics. To explore this, a qualitative study was undertaken at community health centres and private general practice surgeries in four areas of metropolitan South Africa, selected purposively to allow for wide variability in terms of socioeconomic status and ethnicities/race of patient populations. With permission, clinic waiting rooms and patient/provider consultations were observed, and 65 in-depth interviews were undertaken with patients or parents or guardians presenting with children. These interviews were complemented by interviews with health providers (26) and key informants (12). All interviews were recorded, transcribed and imported into NVivo 12 for management. Data were open coded, with individual interviews and observational data compared and contrasted to highlight understandings and practices of care, antibiotic precription and use. In this article, I illustrate how the social context of patient and provider interactions in primary care settings influenced treatment. Community health centres and clinics were (and are) stretched for resources, and there were long wait times before patients can be seen; consultations were brief, with relatively little verbal exchange on the management of coughs and colds. Providers' decisions of treatment were informed by clinical assessment, concern about the risks of bacterial infection, and perceptions of patient ability to seek further care and advice-a mix of clinical and social considerations. While patients did not always request antibiotics and were willing to discuss how to manage acute conditions without them, doctors in private practice still often provided a prescription, sometimes postdated to discourage use but with the option for medication if needed. In the public sector, the provision of a prescription also reflected clinicans' appreciation of economic constraint and vulnerability. As described, patients understood principles of the appropriate use and storage of antibiotics, in contrast to other medications, and they were largely open to discussions with their providers about whether or not to use an antibiotic. However, their own and their prescribing providers had varied understandings of the mechanisms of resistance to antibiotics and so the need for antibiotic stewardship.

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“…Triage (broadly defined as the process of prioritising patients for care based on their needs) [54] has also been shown to reduce waiting times in a hospital in South Africa, though it was less effective when used in two PHC clinics. [55,56] Effective triage can be challenging and resource-intensive to sustain, [57] and sub-optimal implementation of symptom-based triage for TB IPC has been documented by several studies. [58][59][60][61] Active queue management has also been tested: a qualitative study around the use of a 'Fast Queue' in clinics in KZN found that the use of multiple, managed queues was generally well-received by attendees, particularly if accompanied by smooth (i.e., unidirectional) flow and effective communication with HCWs, though there were still those who experienced long waiting times.…”

Section: Potential Interventionsmentioning

confidence: 99%

Waiting times, patient flow, and occupancy density in South African primary health care clinics: implications for infection prevention and control

Karat

McCreesh

Baisley

et al. 2021

Preprint

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Background Transmission of respiratory pathogens, such as Mycobacterium tuberculosis and severe acute respiratory syndrome coronavirus 2, is more likely during close, prolonged contact and when sharing a poorly ventilated space. In clinics in KwaZulu-Natal (KZN) and Western Cape (WC) provinces, South Africa, we estimated clinic visit duration, time spent indoors and outdoors, and occupancy density of waiting rooms. Methods We used unique barcodes to track attendees' movements in 11 clinics in two provinces, multiple imputation to estimate missing arrival and departure times, and mixed-effects linear regression to examine associations with visit duration. Results 2,903 attendees were included. Median visit duration was 2 hours 36 minutes (interquartile range [IQR] 01:36–3:43). Longer mean visit times were associated with being female (13.5 minutes longer; p<0.001) and attending with a baby (18.8 minutes longer; p<0.01), and shorter mean times with later arrival (14.9 minutes shorter per hour after 0700; p<0.001) and attendance for tuberculosis or ante/postnatal care (24.8 and 32.6 minutes shorter, respectively, than HIV/acute care; p<0.01). Overall, attendees spent more of their time indoors (median 95.6% [IQR 46–100]) than outdoors (2.5% [IQR 0–35]). Attendees at clinics with outdoor waiting areas spent a greater proportion (median 13.7% [IQR 1–75]) of their time outdoors. In two clinics in KZN (no appointment system), occupancy densities of ~2.0 persons/m2 were observed in smaller waiting rooms during busy periods. In one clinic in WC (appointment system), occupancy density did not exceed 1.0 persons/m2 despite higher overall attendance. Conclusions Longer waiting times were associated with early arrival, being female, and attending with a young child. Attendees generally waited where they were asked to. Regular estimation of occupancy density (as patient flow proxy) may help staff assess for risk of infection transmission and guide intervention to reduce time spent in risky spaces.

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The role of triage to reduce waiting times in primary health care facilities in the North West province of South Africa

Cited by 10 publications

References 17 publications

Reasons for late presentation for antenatal care, healthcare providers’ perspective

Reasons for late presentation for antenatal care, healthcare providers’ perspective

Prescribing, care and resistance: antibiotic use in urban South Africa

Waiting times, patient flow, and occupancy density in South African primary health care clinics: implications for infection prevention and control

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