Longer patient visits needed for better quality of care

A new study provides further evidence of what many health care experts have long suspected: the quality of care patients receive from their primary care doctor is linked to how much time their doctor spends with them.

The study in JAMA Health Forum uses the appropriateness of prescribing decisions as a proxy for quality of care. Using electronic health record data on more than eight million primary care visits among 4.3 million patients, the authors examined changes in potentially inappropriate prescribing decisions according to the length of primary care visits.

“Potentially inappropriate prescribing decisions” were defined as inappropriate antibiotic prescribing for upper respiratory tract infections, coprescribing opioids and benzodiazepines for pain, and prescriptions that were potentially inappropriate for older adults. The latter were defined as medications the American Geriatrics Society has strongly recommended avoiding for patients 65 and older.

The researchers found that about 56% of visits for upper respiratory tract infections resulted in an inappropriate antibiotic prescription, 3.4% of visits for pain involved coprescribing opioids and benzodiazepines, and 1.1% of visits by patients 65 and older involved prescribing contraindicated medications.

When analyzed according to length of visit, the data showed that for every additional minute of visit length, the likelihood of inappropriate antibiotic prescribing decreased by 0.11 percentage points, while the likelihood of coprescribing opioids and benzodiazepine was reduced by 0.01 percentage points. But potentially inappropriate prescribing among older adults increased very slightly as a function of visit length.

The authors speculate that the differences in the likelihood of inappropriate prescribing may be a function of whether the visit is for an acute or non-acute condition. In a visit focused on a possible upper respiratory tract infection—an acute condition—any additional time in the visit would likely be given over to that specific problem.

In contrast, the other two scenarios in the study are not specific to an acute condition, and consequently may be part of visits for a wide range of concerns so that any additional time might not be used for the problem relevant to the potentially inappropriate prescribing.

The authors note their “particular concerns” regarding associations between patient visit characteristics and visit lengths that couldn’t be explained by differences in perceived patient need. They cite the fact that patients covered by Medicaid, or with dual Medicare/Medicaid coverage or no insurance had significantly shorter visits than patients with commercial insurance, even though the latter population was healthier on average.

In addition, non-Hispanic Black patients had visits that were shorter, on average, than non-Hispanic white patients seeing the same physician. “These visit-level differences may accumulate over time, potentially contributing to racial disparities in how much time patients spend with their physicians each year,” they write.

The study, “Association of Primary Care Visit Length With Potentially Inappropriate Prescribing,” was published online March 10, 2023 in JAMA Health Forum.