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The Increasing Number of Clinical Items Addressed During the Time of Adult Primary Care Visits

Journal of General Internal Medicine volume 23, Article number: 2058 (2008) Cite this article

Abstract

BACKGROUND

Primary care physicians report that there is insufficient time to meet patients’ needs during clinical visits, but visit time has increased over the past decade.

OBJECTIVE

To determine whether the number of clinical items addressed during the primary care visit has increased, and if so, whether this has been associated with changes in visit length and the pace of clinical work.

DESIGN

Analysis of non-hospital-based adult primary care visits from 1997 to 2005, as reported in the National Ambulatory Medical Care Survey.

PARTICIPANTS

A total of 46,431 adult primary care visits.

MEASUREMENTS

We assessed changes over time for the total number of clinical items addressed per visit (including diagnoses, medications, tests ordered, and counseling), visit duration, and average available time per clinical item. In adjusted analyses we controlled for patient and physician characteristics.

RESULTS

The number of clinical items addressed per visit increased from 5.4 to 7.1 from 1997 to 2005 (p < 0.001). Visit duration concurrently increased from 18.0 to 20.9 min (p < 0.001). The increase in the number of clinical items outpaced the increase in duration, resulting in a decrease in time per clinical item from 4.4 to 3.8 (p = 0.04). These changes occurred across patient age and payer status and were confirmed in adjusted analyses.

CONCLUSIONS

The volume of work associated with primary care visits has increased to a greater extent than has visit duration, resulting in less available time to address individual items. These findings have important implications for reimbursing physician time and improving the quality of care.

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Acknowledgements

This study was supported by a Chicago Center of Excellence in Health Promotion Economics Pilot Grant (Drs. Abbo, Zhang, Zelder, and Huang) from a grant from the Centers for Disease Control and Prevention (1 P30 CD000147–01) a National Institutes of Aging Career Development Award (Dr. Huang, K23-AG021963), and a grant from the National Institute of Child Health and Human Development (Dr. Zhang, 1R03-HD056073). This work was presented in preliminary form at the 29th Annual Meeting of the Society for General Internal Medicine in Los Angeles, California, April, 2006.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Section of General Internal Medicine, University of Chicago, Chicago, IL, USA

    Elmer D. Abbo M.D., J.D. & Elbert S. Huang M.D., M.P.H.

  2. School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA

    Qi Zhang Ph.D.

  3. Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA

    Martin Zelder Ph.D.

  4. Department of Economics, Northwestern University, Evanston, IL, USA

    Martin Zelder Ph.D.

  5. The University of Chicago, Chicago, IL, USA

    Elmer D. Abbo M.D., J.D.

Authors
  1. Elmer D. Abbo M.D., J.D.
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  2. Qi Zhang Ph.D.
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  3. Martin Zelder Ph.D.
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  4. Elbert S. Huang M.D., M.P.H.
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Corresponding author

Correspondence to Elmer D. Abbo M.D., J.D..

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ESM

Abstraction of visit data from NAMCS by survey design (DOC 148 KB).

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Abbo, E.D., Zhang, Q., Zelder, M. et al. The Increasing Number of Clinical Items Addressed During the Time of Adult Primary Care Visits. J GEN INTERN MED 23, 2058 (2008). https://doi.org/10.1007/s11606-008-0805-8

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  • DOI: https://doi.org/10.1007/s11606-008-0805-8

KEY WORDS

  • adult
  • primary care
  • clinical items
  • visit duration