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SMS-based time use research among Dutch GPs: an experiment.

Batenburg, R., Hassel, D. van, Velden, L. van der. SMS-based time use research among Dutch GPs: an experiment.: , 2013. 180 p. Abstract. In: Abstractbook EHMA Annual Conference 2013 'What healthcare can we afford? Better, quicker, lower cost health services'. 26-28 juni 2013, Milaan.
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Context: It has become a critical challenge in many countries to ensure sufficient capacity of primary care providers, specifically the capacity of General Practitioners (GPs). In a number of countries, health workforce planning is specifically developed for GPs, increasing the need for reliable and detailed statistics on GP capacity and the net time GPs spend on patient care. The measurement of GPs time use appears to be quite difficult in practice however. There is a need for a new reliable, valid and yet nondemanding method to measure a GPs time use in practice. Methods: We performed a scoping literature review on the type of time-use survey among GPs that has been applied and described in scientific literature over the last 15 year. Our review shows that in most studies self-reporting time use surveys are conducted, using the ex-post ‘diary method'. The main disadvantages of this method are that GPs overestimate their total working time, and underestimate their net time spend on patient care. As an alternative, we developed a real-time and work sampling method to measure time-use among GPs, using Short Message Sending (SMS, or: texting). A total of 14 GPs participated in an experiment during two complete working weeks, receiving a number of (randomly send) time use questions through SMS on their mobile phones. Results: The main goal of the experiments was to explore the actual feasibility of a time-use research among 14 GPs during a working week using a SMS tool on their personal mobile or smart phone. The experiments during both weeks went successfully. The SMS system allowed GPs to text that no messages should be send during certain time slots, as they were certain that no GP-related work was performed. During all other time slots, SMS texts were sent randomly and answered within 30 minutes. One single question was posed: what do you at this moment? Only 4 answers could be replied: (1) not at work, (2) doing direct, (3) indirect or (4) non-patient related work. The main result was that GPs experienced their participation in the SMS-based time use research as pleasurable and non-demanding, as most SMS interactions went quick and easy. Discussion: Measuring time use of GPs through SMS, programmed according to real time and work sampling principles, appears to be feasible. Evaluation interviews after the experiments support that GPs handled the SMS-send questions in an easily and reliable manner. Receiving and answering 5 to 7 messages each day of the week was manageable for all participants. Providing clear instructions and extensive pretesting of the SMS system also contributed to the experiments' success. Still, it should be recognized that GPs were recruited through personal networks, and were somewhat biased in their willingness and curiosity towards the SMS experiment. At the individual level, time use measurements based on the SMS data collected remain inaccurate. Summing these time use data over individuals however, exponentially increases the reliability of the time use estimations. Hence, this appears to be a promising method to roll out on a larger scale, and support national health workforce capacity measurement.