News: Shorter primary care visits correlate with lower-quality care, study says

Shorter primary care visit time is associated with some inappropriate prescribing decisions, according to a new research article published by JAMA Health Forum. For each additional minute of a primary care visit, the study found the probability of an inappropriate antibiotic prescription for upper respiratory tract infections decreased by 0.11%. It also stated that time is a key factor in primary care, with the average visit lasting 18 minutes, and references previous studies that have found patients often report needing more time in primary care visits and the length can factor into patient satisfaction, HealthLeaders reported.

Data for the study was collected from more than eight million primary care visits from more than 8,000 primary care physicians in 2017. It examined three kinds of prescribing decisions: antibiotics for upper respiratory tract infections, co-prescribing of opioids and benzodiazepines, and potentially inappropriate prescribing for older adults.

Researchers found longer primary care visits were associated with more complex care, such as more diagnoses and more chronic conditions coded. The probability of co-prescribing of opioids and benzodiazepines also decreased by 0.01% for each additional minute of a primary care visit.

“In this cross-sectional study of primary care physician visit length, shorter visit length was associated with higher rates of inappropriate antibiotic prescribing for upper respiratory tract infections and inappropriate co-prescribing of opioids and benzodiazepines for patients with painful conditions, but similar patterns were not found for other potentially inappropriate prescribing decisions,” the co-authors wrote. “We found considerable within-physician variation in visit length, with younger, publicly insured, Hispanic, and non-Hispanic Black patients receiving shorter visits.”

The researchers also noted troubling links between patient visit characteristics and visit time that were not easily explained by differences in patient clinical need. “Patients with Medicaid insurance coverage, dual Medicare and Medicaid coverage, or no insurance coverage received significantly shorter visits than commercially insured patients despite the latter population being healthier on average,” they said. “Similarly, non-Hispanic Black patients received visits that were shorter, on average, than non-Hispanic White patients seeing the same physician.”

Increasing the length of patient visits for upper respiratory tract infections could improve antibiotic stewardship, the co-authors said. They recommended that policy makers and health system leaders take note of the association between visit length and inappropriate antibiotic prescribing. Their findings suggest that lengthening upper respiratory tract infection visits may help lower inappropriate antibiotic prescribing.

Editor’s note: To read HealthLeaders’ coverage of this story, click here. To read the JAMA Health Forum study, click here.