Senior Citizens Probably Cause Increase in Primary
Care Visits and Length; Quality Up, Too
Most likely that visit duration increased because it
takes more resources or time to care for an older and sicker population
Nov. 9, 2009 Visits to primary care physicians
increased in frequency, duration and quality between 1997 and 2005, and
the researchers say senior citizens are probably the cause for at least
the increases in frequency and duration.
"Two of the most pressing goals for the U.S. health
care system are to deliver higher-quality care and to lower costs,"
according to the report in the November 9 issue of Archives of
Internal Medicine, one of the JAMA/Archives journals.
Primary care physicians are being held to these
goals while patient populations have grown older and more complex.
Additionally, primary care physicians' net incomes
have decreased by more than 10 percent from 1995 to 2003, raising
concerns that physicians would respond by shortening the time they spend
on each visit in order to see more patients. Research suggests that a
higher investment of primary care physicians' time may be required to
deliver high-quality care.
Lena M. Chen, M.D, M.S., then of the Veterans
Affairs Boston Healthcare System and now of the University of Michigan
Health System, Ann Arbor, and colleagues conducted a retrospective
analysis of 46,250 U.S. visits to primary care physicians by adults age
18 and older between 1997 and 2005.
Researchers set out to determine changes in visit
duration and if visit duration is associated with quality of care.
Quality of care was evaluated using nine medical, counseling or
screening quality indicators used in previous studies.
From 1997 to 2005, U.S. adult primary care visits
to physicians increased by 10 percent, from an estimated 273 million to
338 million annually.
The average visit duration increased from 18
minutes to 20.8 minutes. For general medical examinations, visit
duration increased by 3.4 minutes and for the three most common primary
diagnoses visit duration increased by 4.2 minutes for diabetes mellitus,
by 3.7 minutes for essential hypertension and by 5.9 minutes for
arthropathies (joint diseases).
"Comparing the early period (1997 to 2001) with the
late period (2002 to 2005), quality of care improved for one of three
counseling or screening indicators and for four of six medication
indicators," the authors write.
Visits for counseling or screening generally took
2.6 to 4.2 minutes longer than visits in which patients did not receive
these services, while providing appropriate medication therapy was not
associated with longer visit duration.
"Although it is possible that physicians have
become less efficient over time, it is far more likely that visit
duration has increased because it takes more resources or time to care
for an older and sicker population," the authors conclude.
"Improvements in quality of care will likely
require a combination of investments in systems such as electronic
health records, greater use of other professionals such as nurse
practitioners and better reimbursement to primary care physicians for
the extra time spent."
Editor's Note: This study was supported by the
Massachusetts Veterans Epidemiology Research and Information Center,
Veterans Affairs Boston Healthcare System.
Keep up with the latest news for senior citizens, baby
boomers
Nov. 9, 2009 Visits to primary care physicians
increased in frequency, duration and quality between 1997 and 2005, and
the researchers say senior citizens are probably the cause for at least
the increases in frequency and duration.
