Global health worker visit time variation: A systematic review

The accurate estimation of the time individuals spend in a health consultation can form a crucial input to measuring diagnostic quality, health workforce planning and costing of services globally. To address this, a systematic review was conducted to identify the length of health care visit times accounting for a range of potential modifiers such as the type of healthcare worker, service delivery platform, and clinical decision-making complexity.

The search for visit times was conducted across seven databases and included approaches to capture the relevant grey literature. Data were extracted, quality appraised, and synthesised using meta-analysis. Potential sources of heterogeneity were explored using univariate subgroup analysis and meta-regression.

The search identified 422 studies for inclusion. The average visit time excluding procedures was 19.2 min (95% CI: 16.7-21.6 min) and showed variation across country income classification, region, service delivery platform, health worker and the use of telemedicine. The meta-regression accounted for a degree of the residual heterogeneity compared to the univariate analysis. The models demonstrated statistically significant variation in the visit times based on factors such as the country income classification, telemedicine, and, in certain models, the service delivery platform.

The estimated variation in visit times can help form part of the evidence base to appraise global health systems, inform health workforce planning, and for costing of services globally. Despite the identified evidence, more research is required to fill the considerable evidence gaps of visit times in lower-income countries as 80% of the studies informing the results come from high income and upper-middle income countries.