Are patients' office visits with physicians getting shorter?
Are patients' office visits with physicians getting shorter?
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DOI：
10.1056/nejm200101183440307
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发表时间：
2001-01-18
影响因子：
158.5
通讯作者：
Rosenthal, M
中科院分区：
文献类型：
--
作者：
Mechanic, D;McAlpine, DD;Rosenthal, M
背景资料：许多人认为，管理式医疗给医生带来了压力，要求他们提高工作效率，看更多的病人，花更少的时间在每个病人身上。我们使用了来自国家卫生统计中心的全国门诊医疗调查（NAMCS）和美国医学会的社会经济监测系统（SMS）的全国代表性数据。调查1989年至1998年期间医生的门诊时间。我们评估了管理式医疗或其他预付医疗计划覆盖的就诊趋势（预付费就诊）和非预付费就诊，用于初级和专科护理，用于新的和确定的患者，以及用于常见和严重的诊断。1989年至1998年期间，到医生办公室就诊的人数从6.77亿人大幅增加到7.97亿人，尽管每100人的就诊率没有显著变化。1989年，根据全国医务人员服务委员会的调查，访问办公室的平均时间为16.3分钟，根据服务管理处的调查，访问办公室的平均时间为20.4分钟。根据这两组数据，1989年至1998年期间，平均探视时间增加了1至2分钟。预付费和非预付费就诊的时间都有所增加。非预付费的就诊时间一直比预付费的就诊时间长，尽管差距从1989年的1分钟下降到1998年的0.6分钟。初级和专科护理以及新老患者的就诊时间呈上升趋势。访问的平均长度保持稳定或增加的患者最常见的诊断和最严重的diagnosis.Conclusions：与预期相反，管理的医疗保健的增长一直没有与减少办公室访问的长度。观察到的趋势不能用医生可用性的增加、医生按性别分布的变化或病例组合复杂性的变化来解释。（N Engl J Med 2001;344：198-204.）版权所有（C）2001马萨诸塞州医学会。
Background: Many believe that managed care creates pressure on physicians to increase productivity, see more patients, and spend less time with each patient.Methods: We used nationally representative data from the National Ambulatory Medical Care Survey (NAMCS) of the National Center for Health Statistics and the American Medical Association's Socioeconomic Monitoring System (SMS) to examine the length of office visits with physicians from 1989 through 1998. We assessed the trends for visits covered by a managed-care or other prepaid health plan (prepaid visits) and non-prepaid visits for primary and specialty care, for new and established patients, and for common and serious diagnoses.Results: Between 1989 and 1998 the number of visits to physicians' offices increased significantly from 677 million to 797 million, although the rate of visits per 100 population did not change significantly. The average duration of office visits in 1989 was 16.3 minutes according to the NAMCS and 20.4 minutes according to the SMS survey. According to both sets of data, the average duration of visits increased by between one and two minutes between 1989 and 1998. The duration of the visits increased for both prepaid and non-prepaid visits. Non-prepaid visits were consistently longer than prepaid visits, although the gap declined from 1 minute in 1989 to 0.6 minute in 1998. There was an upward trend in the length of visits for both primary and specialty care and for both new and established patients. The average length of visits remained stable or increased for patients with the most common diagnoses and for those with the most serious diagnoses.Conclusions: Contrary to expectations, the growth of managed health care has not been associated with a reduction in the length of office visits. The observed trends cannot be explained by increases in physicians' availability, shifts in the distribution of physicians according to sex, or changes in the complexity of the case mix. (N Engl J Med 2001;344:198-204.) Copyright (C) 2001 Massachusetts Medical Society.