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Primary Care Visit Length, Quality, and Satisfaction for Standardized Patients with Depression

Journal of General Internal Medicine volume 22, pages 1641–1647 (2007)Cite this article

Abstract

BACKGROUND

The contribution of physician and organizational factors to visit length, quality, and satisfaction remains uncertain, in part, because of confounding by patient presentation.

OBJECTIVE

To determine associations among visit length, quality, and satisfaction when patient presentation is controlled.

DESIGN

A factorial experiment using standardized patients to make primary care visits presenting with either major depression or adjustment disorder, and a musculoskeletal complaint.

PARTICIPANTS

One hundred fifty-two primary care physicians, each seeing 2 standardized patients.

MEASUREMENTS

Visit length was determined from surreptitiously obtained audiorecordings. Other key measures were derived from physician and standardized patient report.

RESULTS

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.

CONCLUSIONS

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.

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Acknowledgements

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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Authors and Affiliations

  1. Division of General Medicine, Department of Internal Medicine, UC Davis, Sacramento, CA, USA

    Estella M. Geraghty MD, MS, MPH

  2. Department of Family and Community Medicine and Center for Healthcare Policy and Research, UC Davis, Sacramento, CA, USA

    Peter Franks MD

  3. Department of Internal Medicine and Center for Healthcare Policy and Research, UC Davis, Sacramento, CA, USA

    Richard L. Kravitz MD, MSPH

Authors
  1. Estella M. Geraghty MD, MS, MPH
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  2. Peter Franks MD
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  3. Richard L. Kravitz MD, MSPH
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Corresponding author

Correspondence to Estella M. Geraghty MD, MS, MPH.

APPENDIX

APPENDIX

Table 4 Questions Assessing Physicians Attitudes Toward Diagnosing and Treating Depression in Primary Care24
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Geraghty, E.M., Franks, P. & Kravitz, R.L. Primary Care Visit Length, Quality, and Satisfaction for Standardized Patients with Depression. J GEN INTERN MED 22, 1641–1647 (2007). https://doi.org/10.1007/s11606-007-0371-5

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KEY WORDS

  • visit length
  • quality
  • satisfaction
  • primary care
  • standardized patient