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Does Good Care Take Longer?

Lena M. Chen, MD, MS; Wildon R. Farwell, MD, MPH; Ashish K. Jha, MD, MPH

Arch Intern Med. 2009;169(20):1866-1872.

Background  It is unclear if increasing pressure on primary care physicians to be more efficient has affected visit duration or quality of care. We sought to describe changes in the duration of adult primary care visits and in the quality of care provided during these visits and to determine whether quality of care is associated with visit duration.

Methods  We conducted a retrospective analysis of visits by adults 18 years or older to a nationally representative sample of office-based primary care physicians in the United States.

Results  Between 1997 and 2005, US adult primary care visits to physicians increased from 273 million to 338 million annually, or 10% on a per capita basis. The mean visit duration increased from 18.0 to 20.8 minutes (P < .001 for trend). Visit duration increased by 3.4 minutes for general medical examinations and for the 3 most common primary diagnoses of diabetes mellitus (4.2 minutes, P = .002 for trend), essential hypertension (3.7 minutes, P < .001 for trend), and arthropathies (5.9 minutes, P < .001 for trend). Comparing the early period (1997-2001) with the late period (2002-2005), quality of care improved for 1 of 3 counseling or screening indicators and for 4 of 6 medication indicators. Providing appropriate counseling or screening generally took 2.6 to 4.2 minutes. Providing appropriate medication therapy was not associated with longer visit duration.

Conclusions  Adult primary care visit frequency, quality, and duration increased between 1997 and 2005. Modest relationships were noted between visit duration and quality of care. Providing counseling or screening required additional physician time, but ensuring that patients were taking appropriate medications seemed to be independent of visit duration.

Author Affiliations: Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System (Drs Chen, Farwell, and Jha), and Divisions of Aging (Dr Farwell) and General Internal Medicine (Dr Jha), Brigham and Women's Hospital and Harvard Medical School, and Department of Health Policy and Management, Harvard School of Public Health (Dr Jha), Harvard University, Boston, Massachusetts. Dr Chen is now with the Division of General Medicine, University of Michigan Health System, Ann Arbor.

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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2009;169(20):1828.
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