Do Shorter Primary Care Visits Lead to More Inappropriate Prescriptions?

Clogged waiting rooms and overworked physicians have become commonplace in the American health system. Recent estimates find the average heath care visit lasts 18 minutes, suggesting primary care physicians would require 27-hour days to fulfill all preventative, chronic disease, and acute care requirements of their patients.

Inadequate time for primary care visits raises concerns about a decreased quality of care. A recent study, published this week in JAMA Health Forum, specifically analyzed whether primary care physicians are more likely to prescribe inappropriate medications during shorter visits.

The impetus for this study was the fear that shorter visits give physicians less time to make diagnoses, discuss treatment regimens, identify potential medication contraindications, and deprescribe as needed. Clinicians may view some prescriptions, for antibiotics or even opioids, as quick fixes when a lack of time inhibits further effort or discussion of alternative treatments. With antimicrobial resistance growing as a preeminent threat to global public health, it is more important than ever to ensure antibiotics are prescribed only as necessary.

The cross-sectional study utilized electronic health records to gather data from primary care offices across the US. The investigators evaluated adult primary care visits that occurred in the year 2017, conducting their analyses from March 2022-January 2023.

First, the investigators examined patient clinical and sociodemographic characteristics correlated with visit length. After controlling for these factors, they determined within-physician changes in potentially inappropriate prescribing decisions by primary care visit duration.

This study examined 3 outcomes representative of potentially inappropriate prescribing: (1) inappropriate antibiotics for upper respiratory tract infections, (2) coprescribing of opioids and benzodiazepines, and (3) potentially inappropriate prescribing for older adults.

The final sample included 8119161 visits among 4360445 patients, seeing 8091 primary care physicians in 4597 practices. The patient cohort was 43.4% male and 56.6% female, and broken down by race and ethnicity, the visiting patients were 68.2% non-Hispanic White, 10.4% non-Hispanic Black, 7.7% Hispanic, 5.5% of another race/ethnicity, and 8.3% with missing race/ethnicity data.

Visit duration was highly variable between and within primary care physicians. The median physician spent an average of 18.9 minutes with each patient. Physicians in the top quartile for visit duration averaged 24.6 minutes or longer with each patient, while physicians in the bottom quartile spent an average of 14.1 minutes or fewer with each patient.

Considering the 3 representatives of potentially inappropriate prescribing, 55.7% of 222667 visits for upper respiratory tract infections involved an inappropriate antibiotic prescription, 3.4% of 1571935 visits for painful conditions involved coprescribing opioids and benzodiazepines, and 1.1% of 2756365 visits for adults aged 65 years and older involved the prescription of contraindicated medications.

The investigators concluded that there was an association between visit length and some potentially inappropriate prescribing. Additionally, shorter visits were most frequent in patients who were younger, publicly insured, Hispanic, or non-Hispanic Black. For each additional minute of visit length, the likelihood of inappropriate antibiotic prescription decreased by -0.11%.