Background
General information
Simulation modelling in health care
Methods
Conceptual models
PHCC | FHU | |
---|---|---|
Timetable
| Working days (8am - 8pm) Weekend (10am - 8pm) | Working days (8am - 8pm) |
Appointment scheduling
| Medical | Medical and nursing |
Medical consultations
| There are patients who are not registered with a GP | All patients are registered with a GP |
Emergency/acute consultations
| Specific timetable to attend these patients, and physicians exclusively allocated to the permanent health unit | Patients are seen by their own GP during FHU normal working hours |
Remuneration
| 42 hours/week-based salary | 35 hours/week-based salary plus variable incentives (B model) |
Case study and computational implementation
Indicator | Mainly informs on... |
---|---|
Appointment scheduling | |
Number of days required to arrange a GP consultation | Accessibility |
Ambulatory consultations
| |
Annual number of consultations per physician | Productivity (Efficiency) |
Time spent in the waiting room (min) | Accessibility |
Emergency/acute consultations
| |
Annual number of acute/emergency consultations per physician | Productivity (Efficiency) |
Waiting time for an acute/emergency consultation (min) | Accessibility |
Nursing consultations
| |
Annual number of nursing consultations per nurse | Productivity (Efficiency) |
Time spent in the waiting room for diabetes, child or prenatal consultations (type 1) (min) | Accessibility |
Time spent in the waiting room for vaccinations or other types of treatments (type 2) (min) | Accessibility |
Costs
| |
Annual costs of diagnostic, medication and other treatments (€) | Costs (Efficiency) |
Annual costs of professionals (€) | Costs (Efficiency) |
Annual total costs (€) | Costs (Efficiency) |
Parameter | Value | Source of information | |
---|---|---|---|
Entry
| Inter-arrival time | Average distribution | Activity reports of each health care unit |
Type of consultation | Probability profile | ||
Number of GPs | Predefined according to each unit | ||
Days for the consultation | Predefined according to each unit | ||
GP's schedule | Predefined according to each unit and respective GP | ||
Internal flows
| Nurse's schedule | Predefined according to each unit and respective nurse | & |
Duration of adult consultations | Log normal distribution | data provided by health care units through their direct contact | |
Duration of other consultations | Log normal distribution | ||
Duration of nursing type 1 consultations | Average distribution | ||
Duration of nursing type 2 consultations | Average distribution | ||
Remuneration
| Cost per consultation with professionals | PHCC (€13.25) FHU (€16.32) | [10] |
Cost per consultation of diagnostic exams, drugs and other treatments | PHCC (€39.20) FHU (€29.20) | [10] | |
Exit
| Patients' re-entry | Probability profile | Activity reports of each health care unit |
Total number of medical consultations | ||||
---|---|---|---|---|
Real | Model | Variation (%) | ||
Benfica
| PHCC Benfica | 38464 | [38356; 39579] | [-0.28; 2.90] |
PHCC Marchal Carmona | 56609 | [56948; 58011] | [0.6; 2.48] | |
PHCC Carnide | 26417 | [25912; 26200] | [-1.91; -0.82] | |
FHU Rodrigues Migueis | 30065 | [29676; 30238] | [-1.29; 0.58] | |
Sete Rios
| PHCC Sete Rios | 141671 | [139235; 140607] | [-1.71; 0.75] |
FHU Tílias | 26425 | [24188; 25189] | [-8.47; -4.61] | |
Carnaxide
| PHCC Linda-a-Velha | 86720 | [83899; 84913] | [-3.25; -2.08] |
PHCC Algés | 54141 | [53724; 54591] | [-1.27; 0.33] | |
FHU Dafundo | 33237 | [33208; 33637] | [-0.08; 1.20] | |
Oeiras
| PHCC Oeiras | 83480 | [78246; 79901] | [-6.27; -4.29] |
PHCC Paço de Arcos | 70853 | [67808; 69567] | [-4.30; -1.82] | |
PHCC Barcarena | 21783 | [21696; 22109] | [-0.40; 1.47] | |
FHU Delta | 34042 | [34135; 34574] | [0.27; 1.56] | |
FHU São Julião | 41186 | [40538; 41164] | [-1.57; -0.05] | |
Cascais
| PHCC Cascais | 76881 | [78160; 80415] | [1.66; 4.60] |
PHCC Estoril | 61556 | [61758; 63117] | [0.33; 2.54] | |
PHCC Alvide | 34636 | [33785; 35599] | [-2.46; 2.78] | |
PHCC Alcabideche | 30631 | [30883; 31094] | [0.81; 1.51] | |
FHU Marginal | 45198 | [44115; 45088] | [-2.40; -0.24] |
Modelling the conversion of a PHCC into a FHU
Results
Indicator | PHCC | FHU | Difference between averages |
---|---|---|---|
Appointment scheduling | |||
Number of days required to schedule a medical consultation | [27; 39] | [14; 17] |
- 54%
|
Medical consultations
| |||
Annual number of consultations per GP | [3914; 4479] | [4197; 4672] |
+ 6%
|
Time spent in the waiting room waiting for an ambulatory consultation (min) | [52; 81] | [27; 42] |
- 48%
|
Emergency/acute consultations
| |||
Annual number of emergency/acute consultations per physician | [488; 794] | [497; 802] |
+ 1%
|
Time spent in the waiting room waiting for an acute/emergency consultation (min) | [6; 26] | [10; 15] |
- 21%
|
Nursing consultations
| |||
Annual number of nursing consultations per nurse | [2319; 2929] | [2145; 2856] |
- 4%
|
Time spent in the waiting room waiting for a nursing type 1 consultation (min) | [5; 9] | [2; 5] |
- 50%
|
Time spent in the waiting room waiting for a nursing type 2 consultation (min) | [7; 15] | [3; 10] |
- 42%
|
Indicator | Before Conversion | After Conversion | Difference between averages |
---|---|---|---|
Accessibility | |||
Number of days required to schedule a medical consultation | [24; 34] | [14; 17] |
-45%
|
Time spent in the waiting room waiting for a medical consultation (min.) | [48; 70] | [33; 43] |
-36%
|
Time spent in the waiting room waiting for an acute/emergency consultation (min.) | [9; 21] | [12; 15] |
-12%
|
Time spent in the waiting room waiting for a nursing type 1 consultation (min.) | [4; 8] | [3; 5] |
-38%
|
Time spent in the waiting room waiting for a nursing type 2 consultation (min.) | [7; 13] | [5; 8] |
-38%
|
Productivity
| |||
Annual number of medical consultations per physician | [4037; 4463] | [4390; 4688] |
7%
|
Annual number of nursing consultations per nurse | [2581; 2695] | [2589; 3169] |
9%
|
Annual number of emergency/acute consultations per physician | [567; 799] | [616; 772] |
2%
|
Costs
| |||
Annual costs with professionals (1000000€) (and with 10% increase in each type of cost, after the conversion, in italic)
| 15
(15)
| 19
(19)
|
25%
38%
|
Annual costs with means of diagnostic, medication and other treatments per primary care unit (1000000€) (and with 10% increase in each type of cost, after the conversion, in italic)
| 41
(41)
| 35
(34)
|
-16%
-7%
|
Annual total costs (1000000€) (and with 10% increase in each type of cost, after the conversion, in italic)
| 57
(57)
| 54
(53)
|
-5%
5%
|