Effects of appointment scheduling on waiting time and utilisation of antenatal care in Mozambique

Maria Steenland, Janeth Dula, Amanda de Albuquerque, Quinhas Fernandes, Rosa Marlene Cuco, Sergio Chicumbe, Eduardo Samo Gudo, Sandra Sequeira, Margaret McConnell, Maria Steenland, Janeth Dula, Amanda de Albuquerque, Quinhas Fernandes, Rosa Marlene Cuco, Sergio Chicumbe, Eduardo Samo Gudo, Sandra Sequeira, Margaret McConnell

Abstract

Background: Poor patient experience, including long waiting time, is a potential reason for low healthcare utilisation. In this study, we evaluate the impact of appointment scheduling on waiting time and utilisation of antenatal care.

Methods: We implemented a pilot study in Mozambique introducing appointment scheduling to three maternity clinics, with a fourth facility used as a comparison. The intervention provided women with a return date and time for their next antenatal care visit. Waiting times and antenatal care utilisation data were collected in all study facilities. We assessed the effect of changing from first come, first served to scheduled antenatal care visits on waiting time and complete antenatal care (≥4 visits during pregnancy). Our primary analysis compared treatment facilities over time; in addition, we compared the treatment and comparison facilities using difference in differences.

Results: We collected waiting time data for antenatal care from 6918 women, and antenatal care attendance over the course of pregnancy from 8385 women. Scheduling appointments reduced waiting time for antenatal care in treatment facilities by 100 min (95% CI -107.2 to -92.9) compared with baseline. Using administrative records, we found that exposure to the scheduling intervention during pregnancy was associated with an approximately 16 percentage point increase in receipt of four or more antenatal care visits during pregnancy.

Conclusions: Relatively simple improvements in the organisation of care that reduce waiting time may increase utilisation of healthcare during pregnancy. A larger scale study is needed to provide information about whether appointment scheduling can be sustained over time.

Trial registration number: NCT02938936.

Keywords: antenatal care; health policy; health systems; maternal health; quality of care.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Intervention logic framework. ANC, antenatal care.
Figure 2
Figure 2
Study timeline.
Figure 3
Figure 3
Distribution of patient arrival times for antenatal care before and after scheduling. Source: Waiting time data collection rounds 1–5. White bars capture rounds 2–5.
Figure 4
Figure 4
Waiting time for antenatal care visits. Source: Waiting time data collected from 19 September to 18 November 2016 (round 1), 12 December 2016 to 20 January 2017 (round 2), 6 February to 10 March 2017 (round 3), 27 March to 28 April 2017, (round 4) and 22 May to 14 July 2017 (round 5).

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