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ORIGINAL ARTICLE
Year : 2021  |  Volume : 25  |  Issue : 2  |  Page : 60-62
 

Study of the basic labor activity of a general practitioner using the time-keeping method on the example of polyclinics of the City of Karaganda, Kazakhstan


1 Department of Public Health, Karaganda State Medical University, 36 Gogol Street, Karaganda City, Kazakhstan
2 RSE “Republic Health Development Center” MoH, Republic of Kazakhstan

Date of Submission23-Jan-2020
Date of Decision21-Sep-2020
Date of Acceptance22-Sep-2020
Date of Web Publication9-Jul-2021

Correspondence Address:
Dr. Leila Stabayeva
Department of Public Health, Karaganda State Medical University, 36 Gogol Street, Karaganda City, 100008
Kazakhstan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoem.IJOEM_18_20

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  Abstract 


Objective: To study and analyze the working time distribution of general practitioners at the outpatient appointment in polyclinics of Karaganda, Kazakhstan. Materials and Methods: The time spent by the general practitioner on all activities was studied by the timing method. Results: a) general practitioners spend a great part of working time for the documentation and organizational measures; therefore, they spend less time for patients; b) it is necessary to maximally unload the doctor from working with documentation. Conclusion: In clinics, it is necessary to properly organize the work of GPs in order to allocate sufficient time to interact with the patients.


Keywords: GPs' workload, general practitioner, labor operations, time observation


How to cite this article:
Mergentay A, Kulov DB, Koikov VV, Omarkulov BK, Sergaliev TS, Imanbayeva G, Stabayeva L. Study of the basic labor activity of a general practitioner using the time-keeping method on the example of polyclinics of the City of Karaganda, Kazakhstan. Indian J Occup Environ Med 2021;25:60-2

How to cite this URL:
Mergentay A, Kulov DB, Koikov VV, Omarkulov BK, Sergaliev TS, Imanbayeva G, Stabayeva L. Study of the basic labor activity of a general practitioner using the time-keeping method on the example of polyclinics of the City of Karaganda, Kazakhstan. Indian J Occup Environ Med [serial online] 2021 [cited 2021 Jul 27];25:60-2. Available from: https://www.ijoem.com/text.asp?2021/25/2/60/321063





  Introduction Top


The improving of population life quality is one of the key areas of the State policy “Densaulyk” of the Republic of Kazakhstan for 2016-2019. One of the ways to achieve this direction is to improve the quality and accessibility of medical services and modernize the health care system at the primary health care level (PHC). The universality of primary health care will be ensured by the further transition to the general practitioners (GPs).[1]

The main and fundamental feature that distinguishes a GP from a local doctor is that the general practitioner should have knowledge in the field of medicine and in other related specialties— psychology, sociology, social medicine, health economics, prevention, etc., His main task is the protection of the families' health, the provision of primary medical care, and the treatment of patients regardless of their age and illness type.[2]

The objective was to study and analyze of working time distribution of four general practitioners in two polyclinics of Karaganda, Kazakhstan.


  Materials and Research Methods Top


The study objects were general practitioners of Polyclinic № 3 and Polyclinic №5 of KazybekBi region of Karaganda city.

The methodology recommendation “Methodology for the developing of time and workload standards of medical personnel” of the Federal State Budgetary Institution “Research Institute of Labor and Social Insurance” of the Ministry of Health of Russian Federation was taken as the basis for timing method studies.[3]

Using this method, the activities of four general practitioners (family doctors) from two random polyclinics of Karaganda (2 GPs from each) were studied. Every patient participated in outpatient appointment gave individual informed consent for the study.

Ethical issues

In our study, we studied the time of patient admission (timing), so there is no need to obtain a decision of the Ethical Clearance Statement.

Before the timing, a list of labor operations and types of work included in the functional responsibilities of GPs was determined. The 7 types of GP activities were identified: main, auxiliary, work with documentation, official conversations, other activities, personal time, and unloaded time.

The timing of the working activities should be sufficient to obtain representative data on labor costs for all labor operations. The required number of timing measurements was determined by the formula recommended by the “Research Institute of Labor and Social Insurance” of the Ministry of Health of Russian Federation:



Where n was the number of timing measurements; was a coefficient corresponding to a given confidence probability (with a probability of 0.95 K = 2); was the standard coefficient of stability of the time series and is defined as the ratio of the maximum value of the time series to the minimum; C is the necessary accuracy of observations (%).

Improving the medical care quality for the population at the outpatient level requires not only increasing financial and material support and providing personnel resources in medicine but also the future rationalization of ways and methods of organizing work at all levels depending on the economic efficiency of the activities carried out.[4],[5],[6]


  Results and Discussion Top


The conditions and organization of the work of GPs were characterized by neuroemotional stress. The GP provided assistance in all types of therapeutic diseases, diseases of the cardiovascular system, nervous pathology, disorders of the musculoskeletal system, otolaryngological and ophthalmological diseases, etc., Within 2 weeks with a 5-day load (Monday–Friday), timekeeping measurements of working time were conducted by GPs. At the same time, they strictly adhered to the rules listed in the methodological manual.

All data on the time spent during the study were recorded in a map of time-keeping observations. We registered in this map the order and name of the types of operations, and the time spent on a particular job. The method of timing measurements of GPs in urban clinics showed that the cost of working time depends on the duties performed. All the activities of the GP were divided into 7 elements of work activity [Table 1].
Table 1: Elements of general practitioner work

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[Table 1] shows the time recorded for 7 types of labor activity (main, auxiliary, work with documentation, service activities, other activities, personal required time, and unloaded time). Before the timing, this technique was tested in 2–3 days. Testing was carried out to identify and correct those or other labor operations. Within 2 weeks, 10 measurements were taken at the same doctor (2–on Mondays, 2–on Tuesdays, 2–on Wednesdays, 2–on Thursdays, and 2–on Fridays).

The time for initial admission of the patient averaged 27.2 ± 3 min. The time for readmission of the patient was much less and amounted to 20 ± 3 min. On average, the time spent per patient was 23.6 ± 3 min [Table 2].[7]
Table 2: Spending time on outpatient appointment in a medical organization (min) M ± δ

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53% of the doctor's time during outpatient appointment was spent for the main activity, which includes anamnesis, thermometry, general examination, percussion, auscultation, blood pressure measurement, advice, recommendations, etc.

35% of the doctor's working time was distributed to work with documentation (records in the outpatient map, viewing the of laboratory results, instrumental and other research, expert consultations) [Figure 1].[8]
Figure 1: The time spent by GPs for labor operations (%)

Click here to view


The assessment of workload in Polyclinic №3 of Karaganda showed the following:

  • not enough time for outpatient appointment;
  • required more time for filling all the necessary data in the computer program and filling the same data in the outpatient card;
  • the workload did not give GPs the opportunity to consider and discuss all the details of the disease as a whole;
  • the GPs had to refine all workers, business matters during off hours;


This leads to a loss of the GP's willingness and their desire to develop in this area.

As a result of the study, the following results were found for GPs of Polyclinic №5 of Karaganda:

  1. GPs performed a double job: recording in the out-patient card (children's cards up to 5 years old) and the same record in the electronic program of Comprehensive Medical Information System.
  2. GPs were forced to arrive 2–3 h earlier than the outpatient appointment began, or to finish the unfinished work with documentation at home.


[Figure 2] shows the time distribution for labor operations of GPs:
Figure 2: The distribution of the main activities of GPs by elements of the labor operation

Click here to view


  • history - 26.5% of total time
  • advice and recommendations - 17% of total time
  • medical examination - 9.8% of total time
  • percussion - 4.1% of total time
  • palpation - 11.2% of total time
  • auscultation - 10.9% of total time.



  Conclusion Top


GPs spend a great part of working time on documentation and organizational work; therefore, they spend less time for patients. Hence, it is necessary to unload GPs with documentation work and properly organize GPs' work in order to allocate sufficient time to interact with the patients.

Informed consent

Informed consent was obtained from the patients/participants who participated in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
The State program for the development of health care of the Republic of Kazakhstan “Densaulyk” for 2016-2019: Approved by the Decree of the President of the Republic of Kazakhstan dated January, 15, 2016, 76.  Back to cited text no. 1
    
2.
Order of the Chairman of the Healthcare Committee of the Ministry of Health, Education and Sport of the Republic of Kazakhstan dated October 12, 1999, №500 “On Approval of the Regulations on the General Practitioner/Family Doctor and the Regulations on Family Outpatient Clinics”.  Back to cited text no. 2
    
3.
Federal State Budgetary Institution “Central Research Institute for Organization and Informatization of Health” of the Ministry of Health of the Russian Federation “Methodology for developing standards for the time and workload of medical personnel”. Moscow, 2013.  Back to cited text no. 3
    
4.
Mergentay A, Kulov DB, Bekembayeva GS, Koikov VV, Omarkulov BK, Mussina GA, et al. Int J Innovation // International Journal of Innovative Science, Enginecring Technology 2017;4.ISSN (Online) 2348-7968-Impact Factor(2016)-.  Back to cited text no. 4
    
5.
On measures to implement the state social policy: The decree of the President of the Russian Federation V.V. 597 dated May 07, 2012 [the Internet]. URL: Available from: http://base.garant.ru/70170950/(Date of appeal December 12, 2016).  Back to cited text no. 5
    
6.
Shevchenko VV. The standard cost of the state (municipal) task as a tool to improve the financial efficiency of health care institutions. Part 2. Health Manage 2014; N 1.- P.37-41.  Back to cited text no. 6
    
7.
Gadzhiev RS, Agalarova LS. Ways to improve the quality and efficiency of labor of district therapists and general practitioners. Directory Gen Practitioner 2017.-N 11.-C.32-39.  Back to cited text no. 7
    
8.
Ivanov V.G. Improving the organization of general medical (family) practice // abstract of thesis. candidate of medical sciences / “Krasnoyarsk State Medical University”. Krasnoyarsk, 2012.-15p.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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