Blumenthal D, Causino N, Chang Y C, Culpepper L, Marder W, Saglam D, Stafford R, Starfield B
Institute for Health Policy, Massachusetts General Hospital/Partners HealthCare System, Inc, Harvard Medical School, Boston, USA.
J Fam Pract. 1999 Apr;48(4):264-71.
The objective of our study was to determine the typical length of ambulatory visits to a nationally representative sample of primary care physicians, and the patient, physician, practice, and visit characteristics affecting duration of visit.
We used an analysis of cross-sectional survey data to determine duration of visit and the characteristics associated with it. The data sources were a random sample of the 19,192 visits by adults to 686 primary care physicians contained in the 1991-1992 National Ambulatory Medical Care Survey, and the results of the Physician Induction Interview conducted by the National Center for Health Statistics. Duration of visit was defined as the total time spent in face-to-face contact with the physician.
Mean duration of visit was 16.3 minutes (standard deviation = 9.7). Multivariate analysis allowed the calculation of the independent effect on visit length of a variety of characteristics of patients, physicians, organizational/practice setting, geographic location, and visit content. Certain patient characteristics (increasing age and the presence of psychosocial problems) were associated with increased duration of visit. Visit content was also associated with increased duration, including ordering or performing 4 or more diagnostic tests (71% increase), Papanicolaou smears (34%), ambulatory surgical procedures (34%), patient admission to the hospital (32%), and 3 preventive screening tests (25%). Reduced duration of visit was associated with availability of non-physician support personnel and health maintenance organization and Medicaid insurance.
Multiple factors affect duration of visit. Clinicians, policymakers, and health system managers should take these considerations into account in managing physician resources during daily ambulatory practice.
我们研究的目的是确定全国具有代表性的初级保健医生门诊就诊的典型时长，以及影响就诊时长的患者、医生、诊所和就诊特征。
我们通过对横断面调查数据进行分析来确定就诊时长及其相关特征。数据来源为1991 - 1992年全国门诊医疗调查中包含的19192名成年人到686名初级保健医生处就诊的随机样本，以及国家卫生统计中心进行的医生入职访谈结果。就诊时长定义为与医生面对面接触所花费的总时间。
就诊平均时长为16.3分钟（标准差 = 9.7）。多变量分析使得能够计算患者、医生、组织/诊所环境、地理位置和就诊内容等各种特征对就诊时长的独立影响。某些患者特征（年龄增长和存在心理社会问题）与就诊时长增加相关。就诊内容也与时长增加相关，包括开具或进行4项或更多诊断检查（增加71%）、巴氏涂片检查（34%）、门诊手术（34%）、患者住院（32%）以及3项预防性筛查检查（25%）。就诊时长缩短与非医生支持人员的可获得性、健康维护组织和医疗补助保险相关。
多种因素影响就诊时长。临床医生、政策制定者和卫生系统管理者在日常门诊实践中管理医生资源时应考虑这些因素。
