By Christopher Cheney
Shorter primary care visit time is associated with some inappropriate prescribing decisions, a new research article found.
Time is a key factor in primary care, with the average visit lasting 18 minutes. Survey data in previous studies has found that patients often report needing more time in primary care visits and the length of primary care visits is one of the most important factors in patient satisfaction.
The new research article, which was published by JAMA Health Forum, is based on data collected from more than 8 million primary care visits in 2017. The data features visits with more than 8,000 primary care physicians.
The researchers examined three kinds of prescribing decisions: antibiotics for upper respiratory tract infections, coprescribing of opioids and benzodiazepines, and potentially inappropriate prescribing for older adults.
The study includes several key data points:
- Longer primary care visits were associated with more complex care such as more diagnoses and more chronic conditions coded
- After adjusting for scheduled visit duration and visit complexity, patients who were younger, publicly insured, Hispanic, and non-Hispanic Black had shorter visits
- For each additional minute of a primary care visit, the probability of an inappropriate antibiotic prescription for upper respiratory tract infections decreased by 0.11 percentage points
- For each additional minute of a primary care visit, the probability of coprescribing of opioids and benzodiazepines decreased by 0.01 percentage points
- There was a statistically insignificant positive association of primary care visit length and potentially inappropriate prescribing among older adults (0.004 percentage points)
Shorter primary care visit length is associated with some inappropriate prescribing decisions and affects some patient groups disproportionately, the study’s co-authors wrote.
“In this cross-sectional study of primary care physician visit length, shorter visit length was associated with higher rates of inappropriate antibiotic prescribing for upper respiratory tract infections and inappropriate coprescribing of opioids and benzodiazepines for patients with painful conditions, but similar patterns were not found for other potentially inappropriate prescribing decisions. We found considerable within-physician variation in visit length, with younger, publicly insured, Hispanic, and non-Hispanic Black patients receiving shorter visits. These findings suggest opportunities for additional research and operational improvements to visit scheduling and quality of prescribing decisions in primary care,” they wrote.
Interpreting the data
With shorter visit length linked to some risk of lower-quality care, the researchers focused on patient and visit characteristics that were tied to time spent with the primary care physicians, the study’s co-authors wrote. “Many of these associations suggest that patients with more medical complexity or with more to discuss received more time with their physicians, which may be expected. For example, visits that included more diagnoses—an imperfect proxy for number of topics discussed—were longer, as were visits for patients with more previously recorded chronic conditions and for new patients.”
The researchers were troubled by links between patient-visit characteristics and visit time that were not readily explained by differences in patient clinical need, they wrote.
“For example, patients with Medicaid insurance coverage, dual Medicare and Medicaid coverage, or no insurance coverage received significantly shorter visits than commercially insured patients despite the latter population being healthier on average. Similarly, non-Hispanic Black patients received visits that were shorter, on average, than non-Hispanic White patients seeing the same physician. These visit-level differences may accumulate over time, potentially contributing to racial disparities in how much time patients spend with their physicians each year.”
Increasing the length of patient visits for upper respiratory tract infections could improve antibiotic stewardship, the co-authors wrote. “Policy makers and health system leaders wishing to advance antibiotic stewardship best practices should take note of the association between visit length and inappropriate antibiotic prescribing. Our findings suggest that lengthening upper respiratory tract infection visits may be a promising strategy to lower inappropriate antibiotic prescribing, which has been a persistent population health concern for decades.”
Christopher Cheney is the senior clinical care editor at HealthLeaders.