Doctor visits get longer, but care quality "poor"

NEW YORK (Reuters Health) - It may come as a surprise to many patients, but a new study shows that primary care visits have actually gotten a little longer since the late 1990s.

This is particularly remarkable, say the researchers, given the increased pressure on primary care doctors to be efficient in the face of rising numbers of patients and declining income.

Nevertheless, based on quality measurements like whether physicians counseled patients on diet and exercise, they found that "overall performance...was poor." Any improvements in care quality will likely require multi-pronged efforts, the researchers say, including paying doctors for spending more time to counsel and screen patients.

Primary care physicians were making about 10 percent less in 2003 than they were in 1995, after taking inflation into account, Dr. Lena M. Chen, who is now with the University of Michigan Health System in Ann Arbor, and her colleagues note in their report in the Archives of Internal Medicine.

"Given the reimbursement environment and the pressures to improve efficiency," they add, "one might worry that primary care physicians would respond by spending less time with each patient to see more patients, improve their efficiency, and boost their incomes."

To see if this was actually true, and to look at whether the quality of care these docs were providing over time got better or worse, Chen and her team analyzed data from the National Ambulatory Medical Care Survey for 1997 through 2005. The survey, run by the National Center for Health Statistics, samples a nationally representative group of office-based physicians annually.

Over the study period, the number of adult visits to primary care physicians rose from 273 million to 338 million, a 10 percent increase on a per person basis. The average visit lasted 18 minutes in 1997, while visit time had increased to nearly 21 minutes by 2005.

While older patients and new patients had longer visits, non-Hispanic black patients and Hispanic patients had significantly shorter visits than whites, the researchers found. They say they were "surprised" by this finding, which "may explain why patients of minority groups do not always receive care that is comparable to that provided to white patients."

During the study period, the quality of care doctors were providing showed "only modest improvements," Chen and her colleagues say, with patients no more likely to get counseling on diet and exercise in 2005 than they were in 1997, even though there's strong evidence that giving high-risk patients this advice is beneficial.

There were improvements in the likelihood of doctors prescribing medications with proven benefit for patients -- for example beta blockers for coronary artery disease or appropriate medications for heart failure, the researchers found.

They 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."

SOURCE: Archives of Internal Medicine, November 9, 2009