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. 2007 Dec;22(12):1641-7.
doi: 10.1007/s11606-007-0371-5. Epub 2007 Oct 6.

Primary care visit length, quality, and satisfaction for standardized patients with depression

Estella M Geraghty  1 , Peter Franks, Richard L Kravitz
Affiliations

Primary care visit length, quality, and satisfaction for standardized patients with depression

Estella M Geraghty et al. J Gen Intern Med. 2007 Dec.

Abstract

Background: The contribution of physician and organizational factors to visit length, quality, and satisfaction remains uncertain, in part, because of confounding by patient presentation.

Objective: To determine associations among visit length, quality, and satisfaction when patient presentation is controlled.

Design: A factorial experiment using standardized patients to make primary care visits presenting with either major depression or adjustment disorder, and a musculoskeletal complaint.

Participants: One hundred fifty-two primary care physicians, each seeing 2 standardized patients.

Measurements: Visit length was determined from surreptitiously obtained audiorecordings. Other key measures were derived from physician and standardized patient report.

Results: Mean visit length for 294 completed encounters was 22.3 minutes (range = 5.8-72.2, SD = 9.4). Key factors associated with visit length were: physician style (rho = 0.68 and 0.54 after multivariate adjustment), nonprofessional experience with depression (11% longer, 95% CI = 0-23%), practicing within an HMO (26% shorter, 95% CI = 61-90%), and greater practice volume (those working >9 half-day clinic sessions/week had 15% shorter visits than those working fewer than 6, 95% CI = 0-27%, and those seeing >12 patients/half-day had 27% shorter visits than those seeing <10 patients/half-day, 95% CI = 13-39%). Suicidal inquiry (a process-based quality-of-care measure for depression) was not associated with adjusted visit length. Satisfaction was linearly associated with visit length but not with suicide inquiry or follow-up interval.

Conclusions: Despite experimental control for clinical presentation, wide variation in visit length persists, largely reflecting individual physician styles. Visit length is a significant determinant of standardized patient satisfaction.

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Figures

Figure 1
Figure 1
Conceptual model and study questions. In this study, standardized patients were used to control for clinical presentation. The numbers correspond to the following study questions: (1) What physician personal and practice characteristics drive visit length? (2) Is quality-of-care (measured by suicidal inquiry) associated with visit length? (3) Do visit length and quality-of-care affect standardized patient satisfaction?
Figure 2
Figure 2
Histograms showing visit length variable before and after log transformation
See this image and copyright information in PMC

References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1056/NEJM200101183440307', 'is_inner': False, 'url': 'https://doi.org/10.1056/nejm200101183440307'}, {'type': 'PubMed', 'value': '11172143', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/11172143/'}]}
    2. Mechanic D, McAlpine DD, Rosenthal M. Are patients’ office visits with physicians getting shorter? N Engl J Med. 2001;344:198–204. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PMC', 'value': 'PMC1371752', 'is_inner': False, 'url': 'https://pmc.ncbi.nlm.nih.gov/articles/PMC1371752/'}, {'type': 'PubMed', 'value': '1777274', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/1777274/'}]}
    2. Heany D, Howie J, Porter A. Factors influencing waiting times and consultation times in general practice. Br J Gen Pract. 1991;41:315–9. - PMC - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '8602709', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/8602709/'}]}
    2. Kaplan SH, Greenfield S, Gandek B, Rogers WH, Ware JE. Characteristics of physicians with participatory decision-making styles. Ann Intern Med. 1996;124:497–504. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '763009', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/763009/'}]}
    2. Hulka BS, Romm FJ, Parkerson GR Jr, Russell IT, Clapp NE, Johnson, FS. Peer review in ambulatory care: use of explicit criteria and implicit judgments. Med Care. 1979;17 (3 Suppl):i–vi, 1–73. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1097/00005650-198310000-00005', 'is_inner': False, 'url': 'https://doi.org/10.1097/00005650-198310000-00005'}, {'type': 'PubMed', 'value': '6656329', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/6656329/'}]}
    2. Hartzema A, Christensen D. Non-medical factors associated with the prescribing volume among family practitioners in an HMO. Med Care. 1983;21:990–1000. - PubMed

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