Chen Lena M, Farwell Wildon R, Jha Ashish K
Division of General Medicine, University of Michigan Health System, 300 N Ingalls St, Room 7C17, Ann Arbor, MI 48109, USA.
Arch Intern Med. 2009 Nov 9;169(20):1866-72. doi: 10.1001/archinternmed.2009.341.
It is unclear if increasing pressure on primary care physicians to be more efficient has affected visit duration or quality of care. We sought to describe changes in the duration of adult primary care visits and in the quality of care provided during these visits and to determine whether quality of care is associated with visit duration.
We conducted a retrospective analysis of visits by adults 18 years or older to a nationally representative sample of office-based primary care physicians in the United States.
Between 1997 and 2005, US adult primary care visits to physicians increased from 273 million to 338 million annually, or 10% on a per capita basis. The mean visit duration increased from 18.0 to 20.8 minutes (P < .001 for trend). Visit duration increased by 3.4 minutes for general medical examinations and for the 3 most common primary diagnoses of diabetes mellitus (4.2 minutes, P = .002 for trend), essential hypertension (3.7 minutes, P < .001 for trend), and arthropathies (5.9 minutes, P < .001 for trend). Comparing the early period (1997-2001) with the late period (2002-2005), quality of care improved for 1 of 3 counseling or screening indicators and for 4 of 6 medication indicators. Providing appropriate counseling or screening generally took 2.6 to 4.2 minutes. Providing appropriate medication therapy was not associated with longer visit duration.
Adult primary care visit frequency, quality, and duration increased between 1997 and 2005. Modest relationships were noted between visit duration and quality of care. Providing counseling or screening required additional physician time, but ensuring that patients were taking appropriate medications seemed to be independent of visit duration.
增加对初级保健医生提高效率的压力是否影响了就诊时长或医疗质量尚不清楚。我们试图描述成人初级保健就诊时长的变化以及这些就诊期间所提供医疗服务的质量，并确定医疗质量是否与就诊时长相关。
我们对美国具有全国代表性的门诊初级保健医生样本中18岁及以上成年人的就诊情况进行了回顾性分析。
1997年至2005年间，美国成年人每年看初级保健医生的次数从2.73亿次增加到3.38亿次，人均增长10%。平均就诊时长从18.0分钟增加到20.8分钟（趋势P<.001）。普通医学检查以及糖尿病（4.2分钟，趋势P=.002）、原发性高血压（3.7分钟，趋势P<.001）和关节病（5.9分钟，趋势P<.001）这三种最常见的主要诊断的就诊时长分别增加了3.4分钟。将早期（1997 - 2001年）与晚期（2002 - 2005年）进行比较，三项咨询或筛查指标中的一项以及六项用药指标中的四项的医疗质量有所改善。提供适当的咨询或筛查通常需要2.6至4.2分钟。提供适当的药物治疗与较长的就诊时长无关。
1997年至2005年间，成人初级保健就诊频率、质量和时长均有所增加。就诊时长与医疗质量之间存在适度关联。提供咨询或筛查需要医生额外的时间，但确保患者服用适当药物似乎与就诊时长无关。
