Radecki S E, Kane R L, Solomon D H, Mendenhall R C, Beck J C
Multicampus Division of Geriatric Medicine, UCLA School of Medicine 90024.
J Am Geriatr Soc. 1988 Aug;36(8):713-8. doi: 10.1111/j.1532-5415.1988.tb07173.x.
In view of the additional time that older persons require for giving and receiving information, as well as for the examination process, it is important for manpower and reimbursement planning to better understand the nature of the physician-patient encounter with the elderly. We examined a series of national surveys of physicians' professional activities and found that physicians tend to spend less time with their older patients and also that encounter time by physicians in different specialties varies widely. Internists and cardiologists spend substantially more time with patients compared with general and family practitioners. For 65-74-year-old ambulatory patients, the average visit lengths are 18.3 minutes for internists, 18.0 for cardiologists, 11.2 for general practitioners, and 12.1 for family practitioners. Compared with ambulatory visit lengths for patients aged 45 to 64 years, average encounter times for 75-year-olds with family physicians were 0.8 minutes shorter, with general practitioners 1.2 minutes shorter, with internists 2.3 minutes shorter, and with cardiologists 3.0 minutes shorter. However, when all characteristics of the visit were considered, the effect of patient age remained significant only for general practitioners. A multivariate analysis of factors related to physician time for ambulatory care showed that more time is associated with multiple problems, problem severity, and the use of diagnostic testing. For general and family practice, the greater the number of previous visits for a problem, the shorter the encounter time is. Additional characteristics associated with shorter physician-patient encounter times include the volume of patients per week and the use of physician assistants within the practice. These findings have implications for medical education and manpower projections.
鉴于老年人在提供和接收信息以及检查过程中需要额外的时间，对于人力和报销计划而言，更好地了解医生与老年患者诊疗过程的本质非常重要。我们研究了一系列关于医生专业活动的全国性调查，发现医生往往与老年患者相处的时间较少，而且不同专科医生的诊疗时间差异很大。与普通医生和家庭医生相比，内科医生和心脏病专家与患者相处的时间要长得多。对于65至74岁的门诊患者，内科医生的平均就诊时间为18.3分钟，心脏病专家为18.0分钟，普通医生为11.2分钟，家庭医生为12.1分钟。与45至64岁患者的门诊就诊时间相比，75岁患者与家庭医生的平均诊疗时间短0.8分钟，与普通医生短1.2分钟，与内科医生短2.3分钟，与心脏病专家短3.0分钟。然而，当考虑就诊的所有特征时，患者年龄的影响仅对普通医生仍然显著。对门诊护理中与医生诊疗时间相关因素的多变量分析表明，更多的时间与多种问题、问题严重程度以及诊断测试的使用有关。对于普通和家庭医疗，针对某个问题之前就诊的次数越多，诊疗时间就越短。与医患诊疗时间较短相关的其他特征包括每周的患者数量以及诊所内医生助理的使用情况。这些发现对医学教育和人力预测具有启示意义。
