title: Strategies for optimizing clinic efficiency in a community-based antiretroviral treatment programme in Uganda.
abstract: We address a critical aspect of antiretroviral therapy (ART) scale-up: poor clinic organization leading to long waiting times and reduced patient retention. Using a before and after study design, time and motion studies and qualitative methods we evaluated the impact of triage and longer clinic appointment intervals (triage) on clinic efficiency in a community-based program in Uganda. We compared time waiting to see and time spent with providers for various patient categories and examined patient and provider satisfaction with the triage. Overall, median time spent at the clinic reduced from 206 to 83 min. Total median time waiting to see providers for stable-ART patients reduced from 102 to 20 min while that for patients undergoing ART preparation reduced 88-37 min. Improved patient flow, patient and provider satisfaction and reduced waiting times allowed for service delivery to more patients using the same staff following the implementation of triage.
authors.affiliation: Medical Department, Reach Out Mbuya HIV/AIDS Initiative, P.O. Box 7303, Kampala, Uganda. stellaalamo@gmail.com
authors.forename: Stella T
authors.initials: ST
authors.lastname: Alamo
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Wagner
authors.forename: Joseph
authors.initials: J
authors.lastname: Ouma
authors.forename: Pamela
authors.initials: P
authors.lastname: Sunday
authors.forename: Laga
authors.initials: L
authors.lastname: Marie
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
authors.forename: Fred
authors.initials: F
authors.lastname: Wabwire-Mangen
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001071:Appointments and Schedules; D017598:Efficiency, Organizational; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D019538:Health Care Surveys; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care; D005791:Patient Care; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D011787:Quality of Health Care; D017748:Time Management; D013996:Time and Motion Studies; D014218:Triage / Q000458:organization & administration*; D014454:Uganda; D014850:Waiting Lists
chemical_list: D019380:Anti-HIV Agents