PCP Appointments Last 5 Minutes or Less In Half the World

Marcia Frellick

November 09, 2017

Primary care appointments last 5 minutes or less in 18 countries that are home to half the world's population, a new study  indicates.

However, average appointment length varies widely, from 48 seconds in Bangladesh to 22.5 minutes in Sweden. The United States was on the high end with an average 20.5 minutes. Appointments in the United Kingdom averaged 9.2 minutes.

Although the length in the United Kingdom has increased steadily over time, the baseline was low, according to the report. "[A]t the current rate of change, the consultation length in the UK would only reach 15 min in 2086," Greg Irving, BMBS, PhD, with the Primary Care Unit at University of Cambridge in the United Kingdom, and colleagues write.

The study was published online November 8 in BMJ Open.

Findings Gathered From 28 Million Appointments

The authors report that this is the largest review of primary care consultation length to date. It covers 179 papers published in six languages from 67 countries, representing 28 million consultations globally.

The results highlight worldwide primary care physician (PCP) shortages and more evidence of factors contributing to provider burnout. The results also question quality of care with such short consultations.

"Little can be achieved in less than 5 min unless the focus is largely on detection and management of gross disease," Dr Irving and colleagues write. "An average of 5 min may be the limit below which consultations amount to little more than triage and the issue of prescriptions."

However, the link between appointment time and outcomes has not been well studied.

"[T]o date, there have been no comprehensive high-quality reviews that collate consultation lengths worldwide and examine how these relate to organisation-level economic and health outcomes," the authors write. "Such information remains vital if nations are to learn from each other."

The researchers did find a link between longer average appointment length and more PCPs per capita. However, in this association, the United States was an outlier because it had one of the longest appointment lengths with a modest PCP density. The authors suggest this may be due to good accessibility to specialists in the United States.

The authors did not find a statistically significant link between length of primary care visit and number of emergency department visits, patient satisfaction with length of the visit, or number of tests requested by the physician.

The researchers found that regular, consistent, and accurate reporting of primary care consultations were lacking and are essential in gauging the quality of health services worldwide.

There are considerable hurdles to uniform reporting. For instance, in countries such as Bangladesh, China, and Pakistan, there is no appointment system and physicians may make more than 90 consultations a day, the authors write. Other countries report numbers irregularly.

The authors encourage countries with sufficient resources to adopt what they consider gold-standard measures, such as Australia's BEACH studies (Bettering the Evaluation and Care of Health), which have consistently high-quality reporting of key statistics, a large sample size, and standardized collection to make annual comparisons possible.

A limitation of the review is that authors could not study differences between rural and urban and public and private practices.

Dr Irving is a clinical lecturer for the National Institute for Health Research (NIHR) and a coauthor is an NIHR doctoral research fellow. Both receive funding from the NIHR.  The other authors have disclosed no relevant financial relationships.

BMJ Open. Published online November 8, 2017. Full text

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