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Time spent with primary care physicians during adult office visits increased from 1997 to 2005, visit duration generally unrelated to quality indicators, data show

Wednesday, December 16 2009 | Comments

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What's This? Office-based primary care physicians appear to spend at least as much time with their adult patients as they did approximately a decade ago, and the length of the actual office visit is only modestly associated with certain quality-of-care indicators, according to the results of a new study.

Researchers noted little is known regarding how much time primary care physicians spend with their patients during office visits and how the duration of the visit affects whether evidence-based care is delivered. They conducted a retrospective analysis using data from the National Ambulatory Medical Care Survey--a nationally representative survey administered by the National Center for Health Statistics--and the U.S. Census Bureau to explore this issue further.

The 9-year study spanned the period of 1997 to 2005, and the analysis included only patients aged >=18 years who made visits to general practitioners, family practitioners, or general internists that included physician contact.

In all, 46,250 adult visits were analyzed.

The researchers evaluated 9 quality indicators that fell into 1 of 2 groups: medication (such as prescribing a statin for hyperlipidemia or a beta-blocker for coronary artery disease [CAD]) and counseling/screening (such as diet counseling or checking blood pressure).

During the study period, adult visits to primary care physicians increased 10% on a per capita basis, from 273 million in 1997 to 338 million in 2005. Despite this increase in the number of visits, the length of time of the office-based interaction increased a significant 16%, from 18.0 minutes in 1997 to 20.8 minutes in 2005.

More specifically, the duration of a general medical examination increased by 3.4 minutes (from 21.7 min. to 25.1 min.), while the duration for visits related to diabetes, essential hypertension, and joint diseases increased by 4.2 min., 3.7 min., and 5.9 min., respectively (P<=.002 for trend).

In terms of patient characteristics, those who were older, newer to the practice, and lived in the South had longer visits. Visits for a general medical examination were significantly shorter for patients who were black or Hispanic.

In terms of quality indicators, researchers reported that providing appropriate medication therapy was generally not associated with longer visit duration, although proper counseling or screening required an additional 2.6 min. to 4.2 min.

Among the 6 medication quality indicators evaluated, 4 improved from the 1997-2001 period to the 2002-2005 period (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for congestive heart failure; treatment for atrial fibrillation; beta-blocker or diuretic for hypertension; and beta-blocker for CAD).

Among the 3 counseling/screening indicators evaluated, 1 improved (checking blood pressure) from the earlier to the later period.

"It may be surprising that primary care physicians are spending more time with patients," the authors of the study commented. "Although it is possible that physicians have become less efficient over time, it is far more likely that visit duration has increased because it takes more resources or time to care for an older and sicker population." (Chen LM, et al. Arch Intern Med 2009;169:1866-1872.)

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