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Am Fam Physician. 2005;72(12):2540

Although the ideal length of an office visit is unknown, studies have shown a relationship between shorter visits and lower quality of care. At the same time, shorter office visits can mean greater productivity for physicians. Lo and associates conducted a study using data from the National Ambulatory Medical Care Survey. This study sought to determine how much time physicians spend with different age groups and identify factors influencing visit length. Because older patients' problems often are more numerous and more complex, the authors hypothesized that more time would be spent with this age group than with younger patients.

This study included participants 45 years and older and drew data from 3,819 visits. Age was broken into three categories: 45 to 64 years, 65 to 74 years, and 75 years and older. The primary independent variable of the study was how much time a family medicine, general practice, or internal medicine physician spent face-to-face with each patient. New patient visits were excluded. The study also evaluated visit characteristics such as reason for the visit, number of visits in preceding 12 months, number of diagnoses, and medications prescribed. The study also categorized visits according to chronic illnesses. Analysis controlled for covariates such as clinic characteristics and presence of comorbid illnesses, and correlated duration of visits with the individual physician's practices.

Older patients (75 years and older) had more chronic problems and more frequent visits to primary care physicians. The mean number of diagnoses for patients 45 to 64 years of age was 1.9. The mean number for older patients was 2.2. This is a statistically significant difference. Older patients also were taking more medications that often required more counseling and more monitoring than the younger group.

Visit duration did not differ significantly after researchers made adjustments for confounding factors. The mean duration times were 17.9 minutes for patients 45 to 64 years of age, 18.4 minutes for patients 65 to 74 years of age, and 18.4 minutes for patients 75 years and older.

Misdiagnosis, lack of preventive care, and incomplete history-taking are associated with shorter office visits. Although illness often increases in complexity and number as patients age, the authors conclude that the mean length of office visits did not increase with age. Given the way in which the calculations of this study were performed, it is possible that the lack of difference in visit duration is because of the greater frequency of visits by older patients. In that case, adequate care might be delivered to older patients over multiple visits. Because counseling and medication issues are essential in geriatric care, more time may be needed to monitor and educate older patients. Although it has not been established that visit duration correlates with quality of care, the authors suggest that a multidisciplinary approach for geriatric patients, particularly with the assistance of ancillary staff, may be needed to provide adequate medical care.

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