Shorter primary care visits result in more inappropriate prescribing

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JAMA Health Forum  |  Hannah Neprash, John Mulcahy, Dori Cross, Joseph Gaugler, Ezra Golberstein, Ishani Ganguli 

Time is a valuable resource in primary care, with both physicians and patients expressing concerns about inadequate time during visits but there is little evidence if shorter visits directly translate to lower quality care. To get at one aspect of this question, LCC members Hannah Neprash and Joseph Gaugler looked to see if shorter visits actually resulted in inappropriate prescribing of antibiotics and opioids. 

The study looked at over 4 million patients and more than 8 million primary care visits. The study found shorter visit lengths were associated with a higher likelihood of inappropriate antibiotic prescribing for patients with upper respiratory tract infections and coprescribing of opioids and benzodiazepines for patients with painful conditions. 

Researchers also found, after controlling for scheduled visit duration and measures of complexity, younger, publicly insured, Hispanic, and non-hispanic Black patients receive shorter primary care visits. These visit-level differences may accumulate over time, potentially contributing to racial disparities in how much time patients spend with their physicians each year. 

"While many studies have documented the fact that Black patients have fewer primary care visits relative to White patients, per year, I believe ours is the first to explore variation in visit length by race/ethnicity and other demographic characteristics," said study author and LCC Member Hannah Neprash.

The results highlight the tension between volume incentives in fee-for-service reimbursement systems of health care and suggest a physician’s time is not always allocated based on patient complexity. The findings suggest there is room for operational improvements to achieve more equitable distribution of care. In particular, policy makers concerned with proper stewardship of antibiotics should take note and consider addressing the issue of visit length association with inappropriate prescribing. 

This research is the result from a project funded by the Life Course Center 2021-2022 pilot grant program. To learn more about our pilot grant program, visit our website. You can also read more about the study in this article in United Press International.