Influence of Appointment System in Heath Care Delivery Services in a State University Teaching Hospital
Chapter One
General Objective
The main objective of this study was to assess the appointment system at the Port Harcourt Teaching Hospital, from patients’ and health providers’ perspectives.
Specific Objectives:
The specific objectives are
- To explore how the perceived attributes of the appointment system affect clients adherence and use of the system.
- To determine client knowledge on the appointment system and how it affects their acceptance of the system and satisfaction with service delivery.
- To examine the enablers and barriers in the implementation of the appointment system from provider and client perspective.
CHAPTER TWO
LITERATURE REVEW
Definition of Concepts
Appointments
White, Froehle, & Klassen (2011) defined follow- up appointments as the period of time allocated in the schedule to a particular patient, for cross-examination of his/her health progress by the physician. The authors further commented that the medical visit is the period of time the physician actually spends with the patient. During this meeting, the patient and physician get more health information that warrants health education, diagnosis or treatment for a condition (White et al., 2011). According to Grunfeld et al., (1996), appointment refers to the actions taken in order to improve health outcome or means of patient revisiting health facility to aid providers to detect recurrence of illness and provide psychosocial support. Appointments need to be carefully managed to ensure efficient use of available resources (Bromage, Napier-Hemy, Payne, & Pearce, 2006). Likewise, Jackson, Shahsahebi, Wedlake, & Dubard, (2015) opined that follow- up appointment and visit is an act where individual visits the hospital requested by the specialist to review a test or monitor treatment progress in order to improve on patients health.
As far as this study is concerned, appointments (Medical appointment and visit) is referred to a clinical encounter in which a patient and practitioner meet at a specific time and place planned in advance to receive health education, counselling, diagnosis, treatment and offered clinical support by healthcare providers. Considering various literatures on the phenomenon under study, appointment refers to the act where a patient is scheduled for a meeting with a particular physician specialist at a specific date and time convenient for both the provider and patient. It is also the means through which patients revisit health facility on providers request for further investigation and routine medical checks of patients recovery and to monitor conditions if treatment is not required.
Appointment is a key part of continuous patient safety. Wimble & Yeong, (2012), asserted that non-adherence or unqualified specialist input during appointment could lead to a missed interpretation of illness, undiagnosed illness, or un-investigated conditions and that may affect patients not properly cared or cured by providers. Saine & Baker (2003) established that appointments are crucial and completed when patients are notified of a prescheduled or cancellation of appointments than ordinarily rescheduling patient’s appointment after visits or changing of appointment schedules without the patients consent. This necessitates the need for patient’s involvement during the scheduling of appointments. Patients involvement during scheduling of appointments provides flexibility, compliance and satisfaction to patients (Rau, 2011).
In addition, satisfied patients during appointment can lead to a reduction in non- adherence rates, helping maintain the continuity of care and improvement in health outcome of patients (Bowser, Utz, Glick, & Harmon, 2010; Feldman, Liu, Topaloglu, & Ziya, 2014; Schectman, Schorling, & Voss, 2008). Further studies indicated that delay and missed appointment does not only increase morbidity or disease progression but reduces efficiency in healthcare delivery that increases the social and economic cost (Karter et al., 2004; McQueenie, Ellis, McConnachie, Wilson, & Williamson, 2023). Therefore, an effective appointment system boosts more structured attendance as well as better care for chronic and other health-related diseases (Al- Haqwi & Al-Shehri, 2007). Hence, the quality of appointments examines the extent or the degree to which healthcare delivery between patients and providers improves the likelihood of desired health outcome during patient’s appointments and visits.
During the Patient visit, the interaction between provider and patients may be shorter or longer than the appointment duration depending on patients conditions or state of health (Mardiah & Basri, 2013). Cayirli & Veral, (2003) asserted that appointment scheduling could be put into two large groups: Static and Dynamic. In the static appointment, all decisions are done before the beginning of a clinic session, and this is the most used appointment system in healthcare (Mardiah & Basri, 2013). For dynamic appointment, based on the current state of the system, the schedule of future arrivals are revised continuously.
Other studies revealed constraints that occur during appointment scheduling especially in healthcare settings, which include; the availability, partial order, non-overlap, patients’ constraints, duration and change in time and also the process of diagnosing (Hannebauer & Müller, 2001). Irrespective of these challenges, the components that was identified in medical appointment scheduling include; starting time of appointment, hospital settings, diagnosis units, advance appointment system, patient’s records, attitude and participation of health providers (Hannebauer & Müller, 2001). Regardless, some principles of patient-centered care during medical visit also include; safety, accessibility, efficiency, equity, emotional support, physical comfort, respect for patients’ preferences and values, access to quality information or communication, continuity and transition of care, among others (Institute of Medicine, 2001; Tomasone et al., 2016).
CHAPTER THREE
RESEARCH METHODOLOGY
Introduction
This chapter discusses the general strategy that was used to conduct the current study. It shows the systematic plan that helped answer the research questions and ultimately address the study objectives. Areas discussed under this chapter include the research design which looked at the general approach and methodology, the study site and target population, a detailed description on how the data were collected and analyzed, the ethical issues that were considered, among others.
Research Design
A cross-sectional study was carried out. The choice of a cross-sectional study was because it allows the researcher to investigate the state of affairs or issues in a population at a specific point in time and how one’s identity guides behaviour change in situations (DeLamater & Ward, 2006; Mingying, 2015). This therefore assisted in identify how perceived attributes of the appointment system affect clients’ adherence and use of the system. It also helped to determine how client knowledge of the appointment system affects their acceptance and satisfaction with the system. Finally, the study was designed to help examine the enablers and barriers in the implementation of appointment system from both provider and client perspective. An explanatory sequential mixed method was used, which is a two-phase design process. During its initail stage, quantitative data was first collected then followed up by qualitative data collection. In this study, designed questionnaires (Appendix I) were used to gather quantitative data from patients (first phase), after which a semi-structured interview guide (Appendix II) was developed based on findings from the quantitative data, to gather qualitative data from both providers and clients (second phase). After which data from the two phases were then integrated in order to achieve the objectives of the study.
Study Population
The study was conducted among patients with neurological diseases who have utilized appointments health services at the Port Harcourt Teaching hospital. Variety of clients are referred from all over the country and neighbouring countries to the UPTH. Service providers at the clinic were also included. This included; nurses, neurologist and other staff involved in service delivery during patients appointments and visits at the neurology clinic.
As of the year 2017, there are 4 neurologist surgeons, and 18 nurses at the surgical unit while the medical unit has 4 nurses, 6 doctors (general practitioners) and 5 main neurologists specialist for both units.
CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
Demographic Characteristics of the Study Participants
Below are demographic information based on gender, age, residence, education, employment status and marital status.
The minimum age of the respondents was 19 years, whereas the maximum age was 90 years. The mean age of respondents was 50.92 years with a standard deviation of 16.52. Table 4.1 presents the age distribution.
CHAPTER FIVE
SUMMARY, RECOMMENDATION AND CONCLUSION
Introduction
This section presents the key findings that were observed in this study. Conclusions that were derived from these findings are also summarized here, based on which recommendations were made. Practical and theoretical implications of this study are also presented in this section. Finally, this section discusses the limitations of the study.
Summary
With regards to attributes of the appointment system and their effect on adherence and usage, this study found that relative advantage, compatibility, complexity, trialability and communicativeness can be used to measure the appointments systems in the hospitals. In terms of the characteristics of the system, “communicativeness” and “trialability” were influential in client adherence to the appointments system in UPTH which is in agreement with other studies. These attributes contribute to the client adherence to the follow-ups appointments and visits system at the UPTH neurology unit.
The findings of this study also revealed that, compatibility, communicativeness and trialability of the system significantly affect the usage of the appointments system by the client at the UPTH. On the contrary, relative advantage and complexity were not statistically significant to the appointments system usage by the clients in UPTH.
With respect to the association between knowledge of appointment system and client acceptance of follow-up visits as well as the association between knowledge of appointments systems and client satisfaction to the system, it was observed that knowledge on the appointments contributes to the acceptance of the system and also influences the satisfaction of the system at UPTH neurology unit.
Concerning enablers and barriers, from the perspective of service providers barriers include; academic engagements, poor adherence to time, distance, poor adherence to appointment schedule and lack of information whiles the enablers were training, and better health outcome. Meanwhile, the patients indicated barriers from their viewpoint to include interpersonal relationship, security and confidentiality, distance, family Support and long waiting time. The enablers from their perspective were; trust, persuasion, guidance on procedures, as well as patient involvement.
Contributions of the study
This study has contributed in various areas including knowledge, policy and practice, as indicated below:
Knowledge
This study has contributed to knowledge of appointment system, especially in relation to neurological care in Nigeria.
Policy
This study has identified areas where policies can be formulated to help in controlling the barriers that were identified as hindrance to the operationalization of the appointment system in neurological care in Nigeria.
Practice
This study has contributed to practice by pointing out to providers, ways by which they can improve upon their channels of disseminating knowledge on the appointments clients. It has also showed the importance of making the system more user-friendly.
Recommendations
In view of the findings, discussions and conclusion of the study, the following recommendations which are relevant to practice, policy and theory research, have been proposed.
Practice
- Providers should improve upon their channels of disseminating knowledge on the appointments to For instance, a television (TV) system in the waiting area could feature pre-recorded programs that would share knowledge on the appointment system. Also, in addition to a phone call, the establishment should find other means of reminding the patients of their appointment dates and time.
- Since compatibility of the system significantly affects its usage, it is recommended that the system should be made in such a way that it would suit all age groups, most importantly the aged as well as the physically The system should be made to be more user-friendly.
Policy
- Policies should be put in place to provide measures to control the barriers that were identified as hindrances to the implementation of the appointment system.
- These policies should be made in such a way that, they can be applied to other health facilities in the
Theory
- Theoretically, this study has established that attributes of the diffusion of innovation theory can be adapted to asses the appointment system in the health sector. Therefore, it is recommended that stakeholders such as hospital management and the ministry of health should continue to search for practical innovative ways of improving the Nigerian health system, specifically in the areas of appointments and visits.
- Communicativeness which was not included as a primary attribute of the earlier proposed diffusion of innovation theory was successfully integrated into this Therefore, this attribute can also be considered when using the theory to test adoption of an innovative idea or system.
Limitations and Recommendations for future research
Emanating from the outcome of the study, the following limitations and recommendations have been made by the researcher:
- This study was limited to only patients with neurological conditions, therefore it is recommended that future studies should look at other diseases conditions that require appointments. Patients suffering from diabetes and hypertension as well as accident patients or dialysis patients that have been discharged who needs appointments and visits are among those that can be considered in future
- This study focused on patients who are currently using the system. Views of new patients or first time visitors, who are trying the system were not assessed. Therefore, future studies can consider examining the views of these individuals in order to ascertain how long it would take for someone to accept the system after trying
- “Communicativeness”, which was integrated as a new attribute to the original DOI theory, needs to be put to rigorous testing in the field, for it to be considered an addition to the original Therefore this testing by other researchers is recommended.
Conclusion
In conclusion, this study established that “communicativeness” and “trialability” were influential in client adherence to the appointments system in the neurology unit of UPTH. Also, compatibility, communicativeness and trialability of the system significantly affect the usage by clients. Additionally, knowledge on the appointments contributes to the acceptance of the system and also influences the satisfaction of the system at the UPTH neurology unit. Finally, barriers in the implementation of appointment system from the perspective of service providers and clients were; academic engagements, poor adherence to time, distance, poor adherence to appointment scheduling, lack of information, interpersonal relationship, security and confidentiality, distance, family support and long waiting time. Enablers were training, better health outcome, trust, persuasion, guidance on procedures, as well as patient involvement.
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