How this fits in
-
We present a new measure "The accumulated annual visit duration" with primary care physicians that had not been evaluated in the literature.
-
Our findings support cumulative duration as a parallel mean to the number of visits for health services assessment. This novel concept may serve as a new standardized comparative measure to evaluate and unify the characteristics of high quality primary care.
-
New primary care guidelines should also refer to the optimal amount of time needed to be spent on health topics within the visit, rather than focusing on the number of visits.
Background
Primary care visits
Visit duration and patient outcomes
The potential implications for resource allocation
Methods
Population and data source
Data accessed
Statistical analysis
Results
Characteristic | N (%) (unless stated otherwise) | |
---|---|---|
N | 77,247 (100) | |
Gender | Female | 40,434 (52.3) |
Age (in years) | Mean (± Range, SD) | 46.5 (20–100, 18.1) |
20–64 | 62,805 (81.3) | |
65+ | 14,442 (18.7) | |
Charlson comorbidity index (n = 77,136) | Mean (± Range, SD) | 3.0 (1–6, 1.1) |
Socioeconomic status | Low SES | 12,185 (15.8) |
Country of birth | New immigrants | 10,128 (13.1) |
Place of residence (n = 77,194) | Large city (≥100,000 citizens) | 31,642 (41.0) |
Other city | 21,970 (28.4) | |
Kibbutz (collective settlement) | 3018 (3.9) | |
Cooperative Israeli settlement | 5162 (6.7) | |
Small town | 6113 (7.9) | |
Non-Jewish settlement | 9289 (12.0) | |
Number of visits to a PCP during 2012 (n = 77,247) | Mean (± Range, SD) Median (± Range, IQR) | 8.8 (0–136, 9.1) 6 (0–136, 10) |
Percentiles | ||
25 | 2.0 | |
50 | 6.0 | |
75 | 12.0 | |
90 | 20.0 | |
AADT (in minutes) spent with a PCP during 2012 (n = 77,247) | Mean (± Range, SD) Median (± Range, IQR) | 65.8 (0–1659, 75.8) 43 (0–1659, 75) |
Percentiles | ||
25 | 15.0 | |
50 | 43.0 | |
75 | 90.0 | |
90 | 155.0 | |
Duration (in minutes) of a single visit to a PCP during 2012 (n = 70,186) | Mean (± Range, SD) Median (± Range, IQR) | 7.6 (0–60, 4.3) 7 (0–60, 4.5) |
No. of visits during 2012 | AADT during 2012 (in minutes) | |||||
Mean (± Range, SD) | 8.8 (0–136, 9.1) | 65.8 (0–1659, 75.8) | ||||
Median (± Range, IQR) | 6 (0–136, 10) | 43 (0–1659, 75) | ||||
Characteristic | Pearson Correlation |
P Value | Pearson Correlation |
P Value | ||
Age (in years) | 0.4 | 0.000 | 0.4 | 0.000 | ||
Charlson comorbidity index | 0.5 | 0.000 | 0.5 | 0.000 | ||
Mean (±SD)
T-TEST
|
P Value | Mean (±SD) T-TEST
|
P Value | |||
Gender | Male | 7.7 (8.9) | <0.001 | 57.5 (73.8) | <0.05 | |
Female | 9.8 (9.2) | 73.3 (76.7) | ||||
Socioeconomic status | Other | 7.7 (8.0) | <0.001 | 58.5 (68.3) | <0.05 | |
Low SES | 14.7 (11.9) | 104.5 (98.4) | ||||
Country of birth | New immigrant | 7.7 (8.1) | <0.05 | 57.1 (67.4) | <0.05 | |
Other | 9.0 (9.2) | 67.1 (76.8) | ||||
Mean (±SD)
ANOVA
|
P Value | Mean (±SD)
ANOVA
|
P Value | |||
Place of residence | Large city | 8.7 (8.9) | <0.05 | 66.9 (75.3) | <0.05 | |
Other city | 8.8 (9.0) | 62.8 (70.0) | ||||
Kibbutz | 11.9 (11.9) | 100.3 (116.9) | ||||
Cooperative Israeli settlement | 8.3 (8.5) | 67.1 (78.0) | ||||
Small town | 8.5 (8.8) | 62.1 (71.9) | ||||
Non-Jewish settlement | 8.7 (9.5) | 59.5 (71.3) | ||||
Chronic Diseases |
N
| Mean (±SD)
T-TEST
|
P Value | Mean (±SD)
T-TEST
|
P Value | |
Malignancy | + | 4250 | 16.4 (12) | <0.05 | 123.5 (103.4) | <0.05 |
− | 72,997 | 8.4 (8.7) | 62.4 (72.4) | |||
Diabetes | + | 9065 | 17.5 (11.9) | 124.6 (100.4) | ||
− | 68,182 | 7.7 (8) | 58 (68.1) | |||
Hypertension | + | 16,848 | 15.9 (11.5) | 115.9 (98.7) | ||
− | 60,399 | 6.8 (7.2) | 51.8 (61) | |||
Hyperlipidemia | + | 27,266 | 13.7 (10.7) | 100.3 (90.8) | ||
− | 49,981 | 6.1 (6.7) | 47 (58) | |||
IHD | + | 5604 | 18.4 (12.6) | 132.9 (107.2) | ||
− | 71,643 | 8.1 (8.3) | 60.5 (70.1) | |||
CHF | + | 985 | 23.1 (15.5) | 165.3 (128.8) | ||
− | 76,262 | 8.6 (8.9) | 64.5 (74) | |||
s/p CVA | + | 2013 | 18.7 (13.8) | 135.2 (114.3) | ||
− | 75,234 | 8.6 (8.8) | 63.9 (73.6) | |||
Asthma | + | 4714 | 12.9 (12.2) | 95.2 (97.7) | ||
− | 72,533 | 8.6 (8.8) | 63.9 (73.7) | |||
COPD | + | 1776 | 20.1 (15.1) | 143.9 (120.9) | ||
− | 75,471 | 8.6 (8.8) | 63.9 (73.4) | |||
Dementia | + | 605 | 16.8 (13) | 113.3 (98.1) | ||
− | 76,642 | 8.8 (9.1) | 65.4 (75.4) | |||
Epilepsy | + | 918 | 13.7 (11.3) | 98.1 (94.7) | ||
− | 76,329 | 8.8 (9.1) | 65.4 (75.4) | |||
Anxiety Disorder | + | 2892 | 16.6 (12.9) | 121.2 (111) | ||
− | 74,355 | 8.5 (8.8) | 63.6 (73.2) | |||
Drug Abuse | + | 496 | 11.3 (12.7) | 82 (95.6) | ||
− | 76,751 | 8.8 (9.1) | 65.7 (75.6) |
Average time per visit (in minutes) | ||
---|---|---|
Age group (in years) | Female | Male |
20–30 | 7.8 | 7.8 |
30–40 | 7.4 | 7.2 |
40–50 | 7.1 | 7.0 |
50–60 | 7.4 | 7.6 |
60–70 | 7.4 | 7.6 |
70–80 | 7.4 | 7.4 |
80–90 | 7.3 | 7.1 |
90–100 | 6.8 | 6.9 |
No. of visits during 2012 R-squared 0.39 | AADT during 2012 R-squared 0.34 | ||||
---|---|---|---|---|---|
Unstandardized Coefficients (B) |
P Value | Unstandardized Coefficients (B) |
P Value | ||
Gender (vs. Male) | Female | 0.2 | 0.000 | 0.5 | 0.000 |
Age (in years vs. 20–30) | 30–40 | 0.0 | <0.05 | 0.0 | 0.999 |
40–50 | 0.2 | 0.5 | <0.05 | ||
50–60 | 0.5 | 1.1 | |||
60–70 | 0.8 | 1.8 | |||
70–80 | 1.0 | 2.4 | |||
80–90 | 0.9 | 2.2 | |||
90–100 | 0.4 | 0.7 | |||
Charlson comorbidity index | For every point added | 0.6 | 0.000 | 1.7 | 0.000 |
Socioeconomic status (vs. Other) | Low SES | 0.3 | 0.000 | 0.7 | 0.000 |
Country of birth (vs. Other) | New immigrant | −0.2 | 0.000 | −0.5 | 0.000 |
Place of residence (vs. Large city) | Other city | 0.0 | 0.000 | −0.1 | 0.000 |
Kibbutz | 0.2 | 0.5 | |||
Cooperative Israeli settlement | 0.0 | 0.1 | |||
Small town | 0.0 | −0.0 | 0.803 | ||
Non-Jewish settlement | 0.0 | 0.0 | 0.083 |