**The Appointment System at the Primary Healthcare Level in Albania Triggered under COVID-19 Pandemic Shows Potential for Better Services**

#### **Joëlle Troxler1,2, Ehadu Mersini2 , Irma Qehajaj1 , B. Nuri2 , and Kaspar Wyss2,3,4**

<sup>1</sup> The Swiss Federal Institute of Technology, Zurich, Switzerland

<sup>2</sup> Health for All Project (HAP), Tirana

<sup>3</sup> Swiss Tropical and Public Health Institute, Allschwil, Switzerland

<sup>4</sup> University of Basel, Basel, Switzerland

While scheduling consultations in PHC settings is common in Western European countries, Albanian public health centers (HC) operate on a walk-in basis. These leads to several problems such as long waiting queues and overcrowded corridors, particularly in the morning hours. To prevent the spread of COVID-19 infections at HC premises, a public HC in Albania implemented an appointment system for patients with NCD, pregnant women, and children. The objective of this paper is to present the findings of the evaluation of the one-year implemented appointment system in an Albanian governmental HC. The employed qualitative approach included in-depth interviews with the HC managerial team, health workers, and patients benefitting from the structured appointed system and a HC operating on a walk-in basis. Additionally, a cost analysis of the appointment system was carried out. The health workers and patients were both very satisfied with the appointment system. The initial fears and concerns of health workers that an appointment system might not be accepted by users could not be confirmed. The appointment system resulted in more efficient service provision to patients with NCDs, children, and pregnant women, as well as longer patientdoctor interactions due to better time management and well-prepared and structured consultations. Furthermore, the new system led to less crowded and noisy corridors, as well as better organized daily work of family doctors and nurses. This has allowed for better compliance with the COVID-19 preventive measures and improved handling of patients infected by the virus through the provision of scheduled home visits and remote and on-site consultations. Main challenges of the system were no-shows of patients, especially at the beginning of the implementation phase, the additional administrative burden of arranging appointments, and the sustainability of the system due to running telephone costs respectively. Appointment systems in PHC allow for improved handling of patient influx during the COVID-19 pandemic and beyond. It has a positive impact on the health service organization, efficiency of service provision and time available for patientdoctor interactions leading to improved care. This positively influences the acceptance of the system among patients and health workers.

Joëlle Troxler1,2, Ehadu Mersini2, Irma Qehajaj1, B. Nuri2, and Kaspar Wyss2,3,4

<sup>1</sup> The Swiss Federal Institute of Technology, Zurich, Switzerland

<sup>2</sup> Health for All Project (HAP), Tirana

<sup>3</sup> Swiss Tropical and Public Health Institute, Allschwil, Switzerland

<sup>4</sup> University of Basel, Basel, Switzerland

#### Background

While scheduling consultations in primary health care settings is common in Western European countries, Albanian public health centres operate on a walk-in basis. These leads to several problems, such as long waiting queues and overcrowded corridors, particularly in the morning hours. To prevent the spread of COVID-19 infections, a public health centre in Albania implemented an appointment system for patients with chronic condition(s), pregnant women, and children. Appointment systems are used to better plan and structure consultations for patients who should be seen by a doctor on a regular basis. The main goal is to deliver timely and convenient access to health care services for all patients.

#### Evaluation of the Albanian Appointment System Advantages


#### Challenges



*Figure 1. Family nurses vaccinating a child (Copyright Bevis Fusha/MoHSP)*

#### Study Design

In 2021, we evaluated the advantages and challenges as well as the costs of one of the first implemented appointment systems in a primary health care centre in Albania. The qualitative approach employed included semistructured in- depth interviews with the health centre managerial team, key health professionals and patients benefitting from the structured appointed system. A cost analysis of the appointment system was carried out, as well.

#### Conclusions

Appointment systems in primary health care allow for an improved handling of patient influx during the COVID-19 pandemic and beyond. They have a positive impact on the health service organization, the efficiency of service provision and the time available for patient–doctor interactions, potentially leading to improved care. This positively influences the acceptance of the system among patients and health workers. A successful and sustainable appointment system in primary health care must be financed and properly supported with information technology (computers, electronic agenda) and a good communication system (phone system).

#### *Table 1. Running costs of appointment system per month*
