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

• Main Authors: Maria Steenland, Janeth Dula, Amanda de Albuquerque, Rosa Marlene Cuco, Sergio Chicumbe, Eduardo Samo Gudo, Sandra Sequeira
• Format: Article
• Language: English
• Published: BMJ Publishing Group 2019-11-01
• Series: BMJ Global Health
• Online Access: https://gh.bmj.com/content/4/6/e001788.full

BackgroundPoor 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.MethodsWe 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.ResultsWe 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.ConclusionsRelatively 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 numberNCT02938936.