Primary Care Visit Length, Quality, and Satisfaction for Standardized Patients with Depression
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The contribution of physician and organizational factors to visit length, quality, and satisfaction remains uncertain, in part, because of confounding by patient presentation.
To determine associations among visit length, quality, and satisfaction when patient presentation is controlled.
A factorial experiment using standardized patients to make primary care visits presenting with either major depression or adjustment disorder, and a musculoskeletal complaint.
One hundred fifty-two primary care physicians, each seeing 2 standardized patients.
Visit length was determined from surreptitiously obtained audiorecordings. Other key measures were derived from physician and standardized patient report.
Mean visit length for 294 completed encounters was 22.3 minutes (range = 5.8–72.2, SD = 9.4). Key factors associated with visit length were: physician style (ρ = 0.68 and 0.54 after multivariate adjustment), nonprofessional experience with depression (11% longer, 95% CI = 0–23%), practicing within an HMO (26% shorter, 95% CI = 61–90%), and greater practice volume (those working >9 half-day clinic sessions/week had 15% shorter visits than those working fewer than 6, 95% CI = 0–27%, and those seeing >12 patients/half-day had 27% shorter visits than those seeing <10 patients/half-day, 95% CI = 13–39%). Suicidal inquiry (a process-based quality-of-care measure for depression) was not associated with adjusted visit length. Satisfaction was linearly associated with visit length but not with suicide inquiry or follow-up interval.
Despite experimental control for clinical presentation, wide variation in visit length persists, largely reflecting individual physician styles. Visit length is a significant determinant of standardized patient satisfaction.
- Mechanic D, McAlpine DD, Rosenthal M. Are patients’ office visits with physicians getting shorter? N Engl J Med. 2001;344:198–204. CrossRef
- Heany D, Howie J, Porter A. Factors influencing waiting times and consultation times in general practice. Br J Gen Pract. 1991;41:315–9.
- Kaplan SH, Greenfield S, Gandek B, Rogers WH, Ware JE. Characteristics of physicians with participatory decision-making styles. Ann Intern Med. 1996;124:497–504.
- Hulka BS, Romm FJ, Parkerson GR Jr, Russell IT, Clapp NE, Johnson, FS. Peer review in ambulatory care: use of explicit criteria and implicit judgments. Med Care. 1979;17 (3 Suppl):i–vi, 1–73.
- Hartzema A, Christensen D. Non-medical factors associated with the prescribing volume among family practitioners in an HMO. Med Care. 1983;21:990–1000. CrossRef
- Andersson S, Mattsson B. Features of a good consultation in general practice: is time important? Scand J Prim Health Care. 1994;12:227–32.
- Deveugele M, Derese A, van den Brink-Muinen A, Bensing J, De Maeseneer J. Consultation length in general practice: cross sectional study in six European countries. BMJ. 2002;325:472–7. CrossRef
- Wilson MA, Childs S. The relationship between consultation length, process and outcomes in general practice: a systematic review. Br J Gen Pract. 2002;52:1012–20.
- Franks P, Bertakis KD. Physician gender, patient gender, and primary care. J Womens Health. 2003;12(1):73–80. CrossRef
- Cooper L, Roter D, Johnson R, Ford D, Steinwachs D, Powe N. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139(11):907–15.
- Radecki SE, Kane RL, Solomon DH, Mendenhall RC, Beck JC. Do physicians spend less time with older patients? J Am Geriatr Soc. 1988;36:713–8.
- Balkrishnan R, Hall MA, Mehrabi D, Chen GJ, Feldman SR, Fleischer AB. Capitation payment, length of visit, and preventive services: evidence from a national sample of outpatient visits. Am J Manag Care. 2002;8(4):332–40.
- Howie J, Porter A, Heany D, Hopton J. Long to short consultation ratio: a proxy measure of quality of care in general practice. Br J Gen Pract. 1991;41:48–54.
- Gross D, Zyzanski S, Borawski E, Cebul R, Stange K. Patient satisfaction with time spent with their physician. J Fam Pract. 1998;47:133–7.
- Hull F, Hull F. Time and the general practitioner: the patient’s view. J R Coll Gen Pract. 1984;34:71–5.
- Anderson R, Barbara A, Feldman S. What patients want: A content analysis of key qualities that influence patient satisfaction. J Med Pract Manage. 2007;22(5):255–61.
- Otani K, Krurz RS, Harris LE. Managing primary care using patient satisfaction measures. J Healthc Manag. 2005;50(5):311–24.
- Safran D, Taira D, Rogers W, Kosinski M, Ware J, Tarlov A. Linking primary care performance to outcomes of care. J Fam Pract. 1998;47:213–20.
- Fiscella K, Franks P, Srinivasan M, Kravitz RL, Epstein R. Ratings of physician communication by real and standardized patients. Ann Fam Med. 2007;5:151–58. CrossRef
- Schulberg HC, Bruce ML, Lee PW, Williams JW, Dietrich AJ. Preventing suicide in primary care patients: the primary care physician’s role. Gen Hosp Psych. 2004;26:337–45. CrossRef
- Williams J, Noel P, Cordes J, Ramirez G, Pignone M. Is this patient clinically depressed? JAMA. 2002;287:1160–70. CrossRef
- Wells KB, Schoenbaum M, Unutzer J, Lagomasino IT, Rubenstein LV. Quality of care for primary care patients with depression in managed care. Arch Fam Med. 1999;8:529–36. CrossRef
- Kravitz RL, Epstein RM, Feldman MD, et al. Influence of patients’ requests for direct-to-consumer advertised antidepressants: a randomized controlled trial. JAMA. 2005;293:1995–2002. CrossRef
- Meredith LS, Rubenstein LV, Rost K, et al. Treating depression in staff-model versus network-model managed care organizations. J Gen Intern Med. 1999;14:39–48. CrossRef
- Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall; 1986.
- Funder D. Toward a social psychology of person judgments: implications for person perception accuracy and self-knowledge. In: Williams K, ed. Social Judgments: Implicit and Explicit Processes. New York: Cambridge University Press; 2003:115–33.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association; 1994.
- Snow V, Lascher S, Mottur-Pilson C. Pharmacologic treatment of acute major depression and dysthymia. Ann Intern Med. 2000;132(9):738–42.
- Stettin GD, Yao J, Verbrugge RR, Aubert RE. Frequency of follow-up care for adult and pediatric patients during initiation of antidepressant therapy. Am J Manag Care. 2006;12:453–61.
- Schulberg HC, Katon W, Simon GE, Rush AJ. An update of the Agency for Health Care Policy and Research Practice Guidelines. Arch Gen Psychiatry. 1998;55:1121–7. CrossRef
- Snijders T, Bosker R. Multilevel Analysis: An Introduction to Basic and Multilevel Modeling. London: Sage; 1999.
- Davidoff F. Time. Ann Intern Med. 1997;127:483–5.
- Weissman JS, Blumenthal D, Silk AJ, et al. Physicians report on patient encounters involving direct-to-consumer advertising: doctors see both the positive and some negative effects on their patients and practices. Health Aff. 2004;W4:219–33.
- Primary Care Visit Length, Quality, and Satisfaction for Standardized Patients with Depression
Journal of General Internal Medicine
Volume 22, Issue 12 , pp 1641-1647
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- visit length
- primary care
- standardized patient
- Industry Sectors
- Author Affiliations
- 1. Division of General Medicine, Department of Internal Medicine, UC Davis, Sacramento, CA, USA
- 2. Department of Family and Community Medicine and Center for Healthcare Policy and Research, UC Davis, Sacramento, CA, USA
- 3. Department of Internal Medicine and Center for Healthcare Policy and Research, UC Davis, Sacramento, CA, USA