{
  "abstract": "Objective: 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. Methods: We analyzed hospital-based survey data from Ecuadorian public hospitals, restricted to adults attending a scheduled outpatient specialist consultation (n = 4,436). Emergency care, unscheduled urgent visits, procedures, and follow-up visits were excluded by design. Access pathway was classified from participants’ 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–Whitney U test. Sociodemographic correlates of non-standardized access were examined using adjusted logistic regression, and adjusted median differences were estimated using quantile regression (τ = 0.50). Effect modification by specialty referral requirement was assessed in a single median regression model using an interaction between access pathway and referral-requirement stratum. Results: 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 −6.2 to −1.0). Adjusted stratum-specific contrasts were −7.9 days (95% CI −13.7 to −2.1) in direct-access specialties and −3.1 days (95% CI −5.9 to −0.2) in referral-required specialties; however, the interaction between access pathway and referral-requirement stratum was not statistically significant (p = 0.136). Conclusion: 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.",
  "abstract_shown": true,
  "affiliations": [
    "School of Dentistry, Universidad Espíritu Santo, Samborondón, Ecuador",
    "Pvalor SAS, Portoviejo, Ecuador"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
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        0
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      "name": "Marcelo Armijos Briones"
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    {
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        1
      ],
      "name": "Emilia Diaz Cercado"
    },
    {
      "name": "Oscar Marcillo-Toala"
    },
    {
      "name": "Patricia Estefanía Ayala Aguirre"
    },
    {
      "name": "Pablo Lenin Benitez Sellan"
    },
    {
      "name": "Antonio Lanata-Flores"
    },
    {
      "name": "Nicole Armijos Bazurto"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/9z5y1w7azab7d.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0349550",
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  "id": "9z5y1w7azab7d",
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    "1932-6203"
  ],
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  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "1407|Healthcare Systems and Technology"
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      "plos",
      "/Earth sciences/Geography/Geographic areas/Urban areas"
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      "/People and places/Geographical locations/South America/Ecuador"
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  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0349550&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-17",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/9z5y1w7azab7d.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:49Z",
      "native_id": "10.1371/journal.pone.0349550",
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      "url": "https://doi.org/10.1371/journal.pone.0349550"
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  "subjects": [
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      "field": "mathematics",
      "origin": "plos:probability theory",
      "subfield": "probability"
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    {
      "field": "medicine",
      "origin": "plos:public and occupational health",
      "subfield": "epidemiology-public-health"
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  "title": "Waiting time for scheduled outpatient specialist consultations by access pathway in public hospitals in Ecuador",
  "title_text": "Waiting time for scheduled outpatient specialist consultations by access pathway in public hospitals in Ecuador",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:49Z",
  "url": "https://research.draconitic.com/paper/9z5y1w7azab7d",
  "venue": "PLOS One",
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}