Abstract
Background
There is growing, widespread recognition that expectations of US primary care vastly exceed the time and resources allocated to it. Little research has directly examined how time scarcity contributes to harm or patient safety incidents not readily capturable by population-based quality metrics.
Objective
To examine near-miss events identified by primary care physicians in which taking additional time improved patient care or prevented harm.
Design
Qualitative study based on semi-structured interviews.
Participants
Twenty-five primary care physicians practicing in the USA.
Approach
Participants completed a survey that included demographic questions, the Ballard Organizational Temporality Scale and the Mini-Z scale, followed by a one hour qualitative interview over video-conference (Zoom). Iterative thematic qualitative data analysis was conducted.
Key Results
Primary care physicians identified several types of near-miss events in which taking extra time during visits changed their clinical management. These were evident in five types of patient care episodes: high-risk social situations, high-risk medication regimens requiring patient education, high acuity conditions requiring immediate workup or treatment, interactions of physical and mental health, and investigating more subtle clinical suspicions. These near-miss events highlight the ways in which unreasonably large patient panels and packed schedules impede adequate responses to patient care episodes that are time sensitive and intensive or require flexibility.
Conclusions
Primary care physicians identify and address patient safety issues and high-risk situations by spending more time than allotted for a given patient encounter. Current quality metrics do not account for this critical aspect of primary care work. Current healthcare policy and organization create time scarcity. Interventions to address time scarcity and to measure its prevalence and implications for care quality and safety are urgently needed.
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Data Availability
The dataset analyzed for this study can be made available upon reasonable request to the corresponding author.
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Acknowledgements
The authors would like to thank the physicians who participated in this study for their time and candor.
Funding
Dr. Sarkar holds current research funding from the National Cancer Institute of the National Institutes of Health, California Healthcare Foundation, the Patient-Centered Outcomes Research Institute, and the Agency for Healthcare Research and Quality. She has received prior grant funding from the Gordon and Betty Moore Foundation, the Blue Shield of California Foundation, HopeLab, the US Food and Drug Administration, and the Commonwealth Fund. She received gift funding from The Doctors Company Foundation. She holds contract funding from InquisitHealth and RecoverX. Dr. Sarkar serves as a scientific/expert advisor for nonprofit organizations HealthTech 4 Medicaid (volunteer) and for HopeLab (volunteer). She is a member of the American Medical Association’s Equity and Innovation Advisory Group (honoraria) and is on the Board of Directors of the Collaborative for Accountability and Improvement (volunteer). She is an advisor for Waymark (shares) and for Ceteri Capital I GP, LLC (shares). She has been a clinical advisor for Omada Health (honoraria), and an advisory board member for Doximity (honoraria, stock). Salary support for Dr. Michelle-Linh Nguyen was provided by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS). Dr. Aoife McDermott was a 2022–23 Commonwealth Fund Harkness Fellow in Health Care Policy and Practice. The views presented here are those of the authors and should not be attributed to the Commonwealth Fund or its directors, officers, or staff.
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Satterwhite, S., Nguyen, ML.T., Honcharov, V. et al. “Good Care Is Slow Enough to Be Able to Pay Attention”: Primary Care Time Scarcity and Patient Safety. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-08658-1
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DOI: https://doi.org/10.1007/s11606-024-08658-1