Knowledge, Attitude and Perceptions of Health Information Management Personnel Towards Appointment System (a Case Study of Federal Medical Centre Idi Aba Abeokuta Ogun State)
CHAPTER ONE
Generalย Objective
The main objective of this study was to assess the appointment system at theย Federal Medical Centre Idi Aba,ย fromย patientsย andย healthย providerโsย perspective.
Specificย Objectives:
Theย specificย objectivesย are:
- To explore how the perceived attributes of the appointment system affect clients adherence and use of the system.
- To determine clientknowledgeย onย the appointmentย systemย andย how itย affectsย theirย acceptanceย of theย systemย and satisfaction with service delivery.
- To examine the enablers and barriers in the implementation of the appointment system from provider and client perspective.
CHAPTERย TWO
LITERATUREย REVEW
Definitionย ofย 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 etย 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,ย McConnachie, Wilson, & Williamson, 2023). Therefore, an effective appointment system boostsย moreย structuredย attendanceย asย wellย asย betterย careย forย chronicย andย otherย health-relatedย diseasesย (Al-ย Haqwi & Al-Shehri, 2007). Hence, the quality of appointments examines theย extent or the degree to which healthcare delivery between patients and providers improves theย likelihoodย ofย desired health outcome duringย 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.
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CHAPTERย THREE
RESEARCH METHODOLOGY
Introduction
This chapter discusses the general strategy that was used to conduct the current study. It showsย the systematic plan that helped answer the research questions and ultimately address the studyย objectives. Areas discussed under this chapter include the research design which looked at theย general approach and methodology, the study site and target population, a detailed description onย howย theย dataย wereย collected andย analyzed,ย the ethical issues thatย wereย considered,ย amongย others.
Researchย Designย
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 oneโs identity guides behaviour change in situations (DeLamater & Ward, 2006; Mingying, 2015). This therefore assisted in identify how perceived attributes of the appointment system affect clientsโ 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
CHAPTERย FOUR
DATAย PRESENTATIONย ANDย ANALYSIS
Demographicย Characteristics ofย theย Studyย Participants
Belowย areย demographicย informationย basedย on gender,ย age, residence,ย education,ย employmentย statusย and marital status.
Theย minimumย ageย ofย theย respondentsย wasย 19ย years,ย whereasย theย maximumย ageย wasย 90ย years.ย The mean age of respondents was 50.92 years with a standard deviation of 16.52. Table 4.1 presentsย theย ageย distribution.
CHAPTERย FIVE
SUMMARY,ย RECOMMENDATIONย ANDย CONCLUSION
Introduction
This section presents the key findings that were observed in this study. Conclusions that wereย derived from these findings are also summarized here, based on which recommendations wereย made.ย Practicalย andย theoreticalย implicationsย ofย thisย studyย areย alsoย presentedย inย thisย section.ย Finally,ย thisย section discusses theย limitations of theย 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, โcommunicativenessโ and โtrialabilityโ 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 ofย the system significantly affect the usage of the appointments system by theย client at the UPTH. On the contrary, relative advantage and complexity were not statisticallyย significantย to theย appointments system usageย byย 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 andย 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 theย system at UPTHย neurologyย 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.
Contributionsย of theย study
Thisย studyย hasย contributedย inย variousย areasย includingย knowledge,ย policyย andย practice, asย indicatedย below:
Knowledgeย
Thisย studyย has contributed to knowledgeย of appointment system,ย especiallyย in relationย toย neurological careย in Nigeria.
Policyย
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 systemย inย neurologicalย careย inย Nigeria.
Practiceย
This study has contributed to practice by pointing out to providers, ways by which they canย improveย upon theirย channels of disseminatingย knowledgeย on theย appointmentsย clients.ย Itย hasย also showed the importanceย of makingย the system moreย user-friendly.
Recommendations
Inย viewย ofย theย findings,ย discussionsย andย conclusionย ofย theย study,ย theย followingย recommendationsย which are relevant to practice, policyย and theoryย research, haveย been proposed.
Practice
- Providers should improve upon their channels of disseminating knowledge on the appointments toย ย 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 physicallyย ย 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 thisย ย Therefore, this attribute can also be considered when using the theory to test adoption of an innovative idea or system.
Limitationsย andย Recommendationsย forย futureย research
Emanating from the outcome of the study, the following limitations and recommendations haveย been madeย byย theย 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 orfirst time visitors, who are trying the system were not assessed. Therefore, future studies canย considerย examiningย theย viewsย ofย theseย individuals inย orderย toย ascertainย how longย itย wouldย takeย forย someoneย to accept theย system after trying
- โCommunicativenessโ, 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 originalย ย Thereforeย this testingย byย otherย researchersย is recommended.
Conclusionย
In conclusion, this study established that โcommunicativenessโ and โtrialabilityโ were influentialย inย clientย adherenceย toย theย appointments systemย inย theย neurologyย unitย ofย UPTH.ย Also,ย compatibility,ย communicativenessย andย trialabilityย ofย theย systemย significantlyย affectย theย usageย by clients. Additionally, knowledge on the appointments contributes to theย acceptanceย ofย theย systemย andย alsoย influencesย theย satisfactionย ofย theย systemย atย theย UPTHย neurologyย unit.ย Finally,ย barriers inย theย implementationย ofย appointmentย systemย fromย theย perspectiveย of service providers and clients were; academic engagements, poor adherence to time, distance,ย poorย adherenceย toย appointmentย scheduling,ย lackย ofย information,ย interpersonalย relationship,ย securityย and confidentiality, distance, family support and long waiting time. Enablers were training, betterย healthย outcome,ย trust, persuasion,ย guidanceย onย procedures,ย as wellย as patientย involvement.
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