Health worker time variation by type of visit: a systematic review

Authors: Murphy P, Raza W, Meheus F, Altea S, Goel K

Abstract:

Introduction:

The time individuals spend in a health consultation or visit (hereafter referred to as ‘visit time’) forms a crucial input to health workforce planning and costing of services. Accurately estimating global variations in visit times by visit complexity and other visit characteristics is important in the evidence base informing policy. Yet to date, there is limited evidence on such variations in visit type. To address this, a systematic review was conducted to identify the length of health care visit times across country and range of potential modifiers such as healthcare worker, service delivery platform and clinical decision-making complexity.

Methods:

A systematic review was conducted across seven databases and included approaches to capturing relevant grey literature. Data were extracted, quality appraised and synthesised. Formal synthesis involved a meta-analysis and meta regression to explore heterogeneity.

Results:

The search identified 365 studies for inclusion in the synthesis. The average visit time based on the naïve estimation varied considerably across country income status, service delivery platform, health worker and the use of telemedicine. The univariate meta-analysis estimated similar variation in visit times to the naïve synthesis but reported high levels of heterogeneity. The meta-regression accounted for a degree of the residual heterogeneity compared to the univariate analysis. The models demonstrated statistically significant coefficients in the form of country income classification, telemedicine and in certain models the service delivery platform. A significant association was estimated between healthcare quality and visit time.

Conclusion:

The estimated variation in visit times can help form part of the evidence base to inform health workforce planning and costing of health services globally.