Estimation of the Time Needed to Deliver the 2020 USPSTF Preventive Care Recommendations in Primary Care

Natalie Privett, PhD; Shanice Guerrier, MS

Disclosures

Am J Public Health. 2020;111(1):145-149. 

In This Article

Abstract and Introduction

Abstract

Objectives: To reexamine the time required to provide the US Preventive Services Task Force (USPSTF)–recommended preventive services to a nationally representative adult patient panel of 2500.

Methods: We determined the required time for a single physician to deliver the USPSTF preventive services by multiplying the eligible population, annual frequency, and patient-contact time required for each recommendation, all calculated by using data from the recommendations themselves and literature. We modeled a representative panel of 2500 adults based on the 2010 US Census Bureau data.

Results: To deliver the USPSTF recommended preventive services across a 2500 adult patient panel would require 8.6 hours per working day, accounting for 131% of available physician time. Compared with 2003, there are fewer recommendations in 2020, but they require 1.2 more physician patient-contact hours per working day.

Conclusions: The time required to deliver recommended preventive care places unrealistic expectations on already overwhelmed providers and leaves patients at risk. This is a systems problem, not a time-management problem. The USPSTF provides a set of recommendations with strong evidence of positive impact. It is imperative that our health care system is designed to deliver.

Introduction

For primary care, there is an increasing gap between what is expected and what is realistic. Our expectations of these physicians have been ever increasing. The increase in workload per primary care visit has far outpaced any increase in visit duration, resulting in more to accomplish in less time.[1] Not surprisingly, physicians are feeling more rushed, overwhelmed, and less effective than ever before.[2,3]

In addition to providers, patients are suffering. Preventive care rates remain startlingly low, putting millions of patients at unnecessary risk each year. Less than half of adults aged 65 years or older are up to date on core preventive services with significant racial and ethnic disparities placing a large number at particular disadvantage.[4] Many reasons have been posited for these low rates,[5] but the most significant barrier is time.

More than 15 years ago, Yarnall et al. contributed one of the most comprehensive efforts to quantify the gap between the expectation and reality of primary care by estimating the amount of time required to deliver the 1996 US Preventive Services Task Force (USPSTF) recommendations to a nationally representative patient panel.[6] Their main finding was that there was not enough time to deliver the recommended preventive services.

During the years since this work was published, a lot has changed—guidelines, population demographics, and advancements, such as health information technology, decision aids, and team-based care. This analysis provides an update on the original work of Yarnall et al.,[6] analyzing the current time requirements for preventive care recommendations. Our specific results differ from those of Yarnall et al., but the conclusion is unchanged: there still is not enough time for prevention.

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