Time allocation in primary care office visits
Time allocation in primary care office visits
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DOI：
10.1111/j.1475-6773.2006.00689.x
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发表时间：
2007-10-01
影响因子：
3.4
通讯作者：
Zhang, Weimin
中科院分区：
文献类型：
--
作者：
Tai-Seale, Ming;McGuire, Thomas G.;Zhang, Weimin
目的使用一种创新的录像分析方法，以检查如何门诊时间花费在老年患者的访问初级保健医生。次要目标是确定的因素，影响时间allocations.Data SourcesA方便的样本392录像带的例行办公室访问1998年和2000年之间进行的多个初级保健的做法，在美国，辅以病人和医生surveillance.Research设计录像访问进行了检查访问长度和时间专门用于特定的主题，一种新的方法来研究时间分配。生存分析模型分析了患者，医生和医生的做法设置如何门诊时间spent.Principal Findings非常有限的时间量是专门用于在办公室访问的特定主题的影响。访问时间的中位数为15.7分钟，涵盖六个主题的中位数。最长的题目大约花了5分钟，其余题目各花了1.1分钟。虽然患者和医生在一个主题上花费的时间会受到许多因素的影响，但即使访问内容差异很大，访问的总体长度也几乎没有变化。宏观因素与每个网站访问和主题长度比问题patients presented.Conclusions的性质有更大的影响，许多主题的访问时间竞争，导致少量的时间花在每个主题。一个高度严格的时间表可能会干扰有足够的时间为复杂或多个问题的患者。提高医疗质量的努力需要认识到病人和医生的时间压力，经济激励的影响，以及改善医患互动的时间成本。
Objectives To use an innovative videotape analysis method to examine how clinic time was spent during elderly patients' visits to primary care physicians. Secondary objectives were to identify the factors that influence time allocations.Data Sources A convenience sample of 392 videotapes of routine office visits conducted between 1998 and 2000 from multiple primary care practices in the United States, supplemented by patient and physician surveys.Research Design Videotaped visits were examined for visit length and time devoted to specific topics-a novel approach to study time allocation. A survival analysis model analyzed the effects of patient, physician, and physician practice setting on how clinic time was spent.Principal Findings Very limited amount of time was dedicated to specific topics in office visits. The median visit length was 15.7 minutes covering a median of six topics. About 5 minutes were spent on the longest topic whereas the remaining topics each received 1.1 minutes. While time spent by patient and physician on a topic responded to many factors, length of the visit overall varied little even when contents of visits varied widely. Macro factors associated with each site had more influence on visit and topic length than the nature of the problem patients presented.Conclusions Many topics compete for visit time, resulting in small amount of time being spent on each topic. A highly regimented schedule might interfere with having sufficient time for patients with complex or multiple problems. Efforts to improve the quality of care need to recognize the time pressure on both patients and physicians, the effects of financial incentives, and the time costs of improving patient-physician interactions.