We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Primary care visit length, quality, and satisfaction for standardized patients with depression.
- Authors
Geraghty, Estella M.; Franks, Peter; Kravitz, Richard L.
- Abstract
<bold>Background: </bold>The contribution of physician and organizational factors to visit length, quality, and satisfaction remains uncertain, in part, because of confounding by patient presentation.<bold>Objective: </bold>To determine associations among visit length, quality, and satisfaction when patient presentation is controlled.<bold>Design: </bold>A factorial experiment using standardized patients to make primary care visits presenting with either major depression or adjustment disorder, and a musculoskeletal complaint.<bold>Participants: </bold>One hundred fifty-two primary care physicians, each seeing 2 standardized patients.<bold>Measurements: </bold>Visit length was determined from surreptitiously obtained audiorecordings. Other key measures were derived from physician and standardized patient report.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
PRIMARY care; MENTAL depression; PATIENT psychology; MUSCULOSKELETAL system; SOUND recordings; AUDITING; RESEARCH; KEY performance indicators (Management); HEALTH maintenance organizations; PHYSICIAN-patient relations; TIME; SIMULATED patients; RESEARCH methodology; PATIENT satisfaction; EVALUATION research; MEDICAL cooperation; PRIMARY health care; COMPARATIVE studies; CLINICAL medicine; EMPLOYEES' workload; RESEARCH funding; MEDICAL appointments
- Publication
JGIM: Journal of General Internal Medicine, 2007, Vol 22, Issue 12, p1641
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-007-0371-5