VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.
Institute for Health Policy Innovation, University of Michigan School of Medicine, 2800 Plymouth Rd, Building 16, Ann Arbor, MI 48109, USA.
BMJ. 2018 Dec 13;363:k4983. doi: 10.1136/bmj.k4983.
To investigate the credibility of claims that general practitioners lack time for shared decision making and preventive care.
Monte Carlo microsimulation study.
Primary care, United States.
Sample of general practitioners (n=1000) representative of annual work hours and patient panel size (n=2000 patients) in the US, derived from the National Health and Nutrition Examination Survey.
The primary outcome was the time needed to deliver shared decision making for highly recommended preventive interventions in relation to time available for preventive care-the prevention-time-space-deficit (ie, time-space needed by doctor exceeding the time-space available).
On average, general practitioners have 29 minutes each workday to discuss preventive care services (just over two minutes for each clinic visit) with patients, but they need about 6.1 hours to complete shared decision making for preventive care. 100% of the study sample experienced a prevention-time-space-deficit (mean deficit 5.6 h/day) even given conservative (ie, absurdly wishful) time estimates for shared decision making. However, this time deficit could be easily overcome by reducing personal time and shifting gains to work tasks. For example, general practitioners could reduce the frequency of bathroom breaks to every other day and skip time with older children who don't like them much anyway.
This study confirms a widely held suspicion that general practitioners waste valuable time on "personal care" activities. Primary care overlords, once informed about the extent of this vast reservoir of personal time, can start testing methods to "persuade" general practitioners to reallocate more personal time toward bulging clinical demands.
调查一般从业者缺乏时间进行共享决策和预防保健的说法是否可信。
蒙特卡罗微模拟研究。
美国初级保健。
从全国健康和营养检查调查中得出的美国年度工作时间和患者小组规模（n=2000 名患者）具有代表性的一般从业者（n=1000）样本。
主要结果是与预防保健时间空间赤字（即医生所需的时间空间超过可用时间空间）相关的高度推荐预防干预措施进行共享决策所需的时间。
一般从业者平均每天有 29 分钟与患者讨论预防保健服务（每个就诊仅需两分钟多一点），但他们需要大约 6.1 小时才能完成预防保健的共享决策。即使对共享决策进行保守（即荒谬的一厢情愿）的时间估计，研究样本中 100%的人都经历了预防时间空间赤字（平均每天赤字 5.6 小时）。然而，通过减少个人时间并将收益转移到工作任务上，这个时间赤字可以很容易地克服。例如，一般从业者可以将浴室休息的频率降低到每两天一次，并跳过与那些不喜欢他们的年长孩子在一起的时间。
这项研究证实了人们普遍怀疑一般从业者在“个人护理”活动上浪费宝贵时间的看法。一旦初级保健主管了解到个人时间的巨大储备程度，就可以开始测试各种方法，以“说服”一般从业者将更多的个人时间重新分配给不断增加的临床需求。
