{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:06:49Z","timestamp":1789668409668,"version":"4.0.1"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Objective<\/jats:title>\n To quantify waiting time in days for scheduled outpatient specialist consultations and to compare waiting time between standardized and non-standardized access pathways in Ecuadorian public hospitals.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We analyzed hospital-based survey data from Ecuadorian public hospitals, restricted to adults attending a scheduled outpatient specialist consultation (n\u2009=\u20094,436). Emergency care, unscheduled urgent visits, procedures, and follow-up visits were excluded by design. Access pathway was classified from participants\u2019 self-report as standardized (institutional or system-based) or non-standardized (informal or non-system-based). Waiting time, defined as the number of days between obtaining the appointment and attending the consultation, was compared using the Mann\u2013Whitney U test. Sociodemographic correlates of non-standardized access were examined using adjusted logistic regression, and adjusted median differences were estimated using quantile regression (\u03c4\u2009=\u20090.50). Effect modification by specialty referral requirement was assessed in a single median regression model using an interaction between access pathway and referral-requirement stratum.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Non-standardized access was associated with shorter waiting times than standardized access. In median regression adjusted for sociodemographic covariates, specialty, and hospital, with hospital-clustered inference, non-standardized access was associated with a 3.6-day shorter conditional median waiting time (95% CI \u22126.2 to \u22121.0). Adjusted stratum-specific contrasts were \u22127.9 days (95% CI \u221213.7 to \u22122.1) in direct-access specialties and \u22123.1 days (95% CI \u22125.9 to \u22120.2) in referral-required specialties; however, the interaction between access pathway and referral-requirement stratum was not statistically significant (p\u2009=\u20090.136).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Among patients who attended a scheduled outpatient specialist consultation in Ecuadorian public hospitals, non-standardized access was associated with shorter waiting times. Although the adjusted point estimate was larger in direct-access specialties, the formal interaction test did not provide clear evidence that the association differed according to specialty referral requirement.<\/jats:p>\n These findings suggest that, within routine outpatient care, parallel access pathways may shape timeliness and warrant greater transparency in appointment allocation and referral coordination.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0349550","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T17:32:23Z","timestamp":1789666343000},"page":"e0349550","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Waiting time for scheduled outpatient specialist consultations by access pathway in public hospitals in Ecuador"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5500-4768","authenticated-orcid":true,"given":"Marcelo","family":"Armijos Briones","sequence":"first","affiliation":[{"name":"Universidad Esp\u00edritu Santo","place":["Samborond\u00f3n, Ecuador"],"department":["School of Dentistry"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Diaz Cercado","sequence":"additional","affiliation":[{"name":"Universidad Esp\u00edritu Santo","place":["Samborond\u00f3n, Ecuador"],"department":["School of Dentistry"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"Marcillo-Toala","sequence":"additional","affiliation":[{"name":"Universidad Esp\u00edritu Santo","place":["Samborond\u00f3n, Ecuador"],"department":["School of Dentistry"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia Estefan\u00eda","family":"Ayala Aguirre","sequence":"additional","affiliation":[{"name":"Universidad Esp\u00edritu Santo","place":["Samborond\u00f3n, Ecuador"],"department":["School of Dentistry"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6674-6142","authenticated-orcid":true,"given":"Pablo Lenin","family":"Benitez Sellan","sequence":"additional","affiliation":[{"name":"Universidad Esp\u00edritu Santo","place":["Samborond\u00f3n, Ecuador"],"department":["School of Dentistry"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Lanata-Flores","sequence":"additional","affiliation":[{"name":"Universidad Esp\u00edritu Santo","place":["Samborond\u00f3n, Ecuador"],"department":["School of Dentistry"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Armijos Bazurto","sequence":"additional","affiliation":[{"name":"Pvalor SAS","place":["Portoviejo, 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