Medscape Medical News, WebMD – Shorter visits between patients and their primary care physicians may be associated with a higher likelihood of inappropriate prescribing, researchers have found.
The study, published online March 10 in JAMA Health Forum, found that as the duration of visits decreased, doctors more often wrote unwarranted prescriptions of antibiotics for upper respiratory tract infections.
They also were more likely to coprescribe opioids and benzodiazepines for patients with pain-related diagnoses, which can increase the risk of a life-threatening overdose.
“Whether it’s patients or whether it’s doctors, everyone feels like they don’t get enough time together,” said Hannah Neprash, PhD, assistant professor at the University of Minnesota School of Public Health and lead author of the study. “So, I really wanted to understand how important that is for the quality of care people get.”
Neprash and colleagues analyzed electronic health record data from more than 8 million primary care visits in 2017. The study included more than 4.3 million patients and 8091 primary care physicians.
The effect of visit length on the possibility of inappropriate prescribing is relatively low but clear.
Over the entire sample of primary care visits, each additional minute of visit length decreased the likelihood of an inappropriate antibiotic by 0.11 percentage points, and the likelihood of opioid and benzodiazepine coprescribing changed by 0.01 percentage points.
For example, nearly 57% of visits lasting 10 minutes resulted in inappropriate antibiotic prescribing. The number drops to below 54% for 20-minute visits.
To determine inappropriate antibiotic prescribing, the researchers implemented a widely used definition relying on the presence of an antibiotic prescription linked with the diagnosis of an upper respiratory tract infection.
Similarly, they defined opioid and benzodiazepine coprescribing as a visit with a pain-related primary diagnosis and both an opioid and a benzodiazepine prescription linked to the visit.
Overall, younger, publicly insured, Hispanic, and Black patients all had shorter visits with their primary care physicians — by about half a minute, on average.
Neprash stressed that although that number looks small, the gap could exacerbate racial and socioeconomic health inequities over time …
