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.
KEY WORDSvisit length quality satisfaction primary care standardized patient
This research was supported in part by a training award to Dr. Geraghty (Health Resources Services Administration grant no. D55 HP00232) and by grants from the National Institutes of Health (R01-MH064683 and K24-MH072756) to Dr. Kravitz.
Conflict of interest
The sponsors played no role in the collection, management, analysis, or interpretation of the data. All of the authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The authors have no other financial interests, disclosures, or conflicts of interest to report.
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