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

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dc.contributor.author Leslie, Hannah H.
dc.contributor.author Laos, Denisse
dc.contributor.author Cárcamo Cavagnaro, César Paul Eugenio
dc.contributor.author Pérez-Cuevas, Ricardo
dc.contributor.author Garcia Funegra, Patricia Jannet
dc.date.accessioned 2021-04-13T20:50:58Z
dc.date.available 2021-04-13T20:50:58Z
dc.date.issued 2021
dc.identifier.uri https://hdl.handle.net/20.500.12866/9119
dc.description.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. en_US
dc.language.iso eng
dc.publisher BioMed Central
dc.relation.ispartofseries BMC Health Services Research
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject adult en_US
dc.subject human en_US
dc.subject Peru en_US
dc.subject patient care en_US
dc.subject article en_US
dc.subject absenteeism en_US
dc.subject Absenteeism en_US
dc.subject doctor nurse relation en_US
dc.subject electronic health record en_US
dc.subject feasibility study en_US
dc.subject health care facility en_US
dc.subject Health information systems en_US
dc.subject health workforce en_US
dc.subject medical information system en_US
dc.subject midwife en_US
dc.subject motion en_US
dc.subject outpatient en_US
dc.subject primary health care en_US
dc.subject Primary health care en_US
dc.subject probability en_US
dc.subject Time motion en_US
dc.subject urban health en_US
dc.title Health care provider time in public primary care facilities in Lima, Peru: a cross-sectional time motion study en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1186/s12913-021-06117-9
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.02
dc.relation.issn 1472-6963


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