Abstract
BACKGROUND
Patient care provided by primary care physicians outside of office visits is important for care coordination and may serve as a substitute for office visits.
OBJECTIVES
To describe primary care physicians’ ambulatory patient care activities outside of office visits (“AOVs”) and their perceptions of the extent to which AOVs substitute for visits and may be performed by support staff.
DESIGN
Cross-sectional direct observational study.
PARTICIPANTS
Thirty-three general internists in 20 practices in two health care systems (one public, one private) in the New York metropolitan area.
MAIN MEASURES
Duration of AOVs by type of activity and whether they pertain to a patient visit on the study day (visit specific) or not (non-visit specific). Physician perceptions of the: (1) extent that non-visit-specific AOVs substitute for visits that would have otherwise occurred, (2) extent that visits that occurred could have been substituted for by AOVs, and (3) potential role of support staff in AOVs.
KEY RESULTS
Physicians spent 20% of their workday performing AOVs, 62% of which was for non-visit specific AOVs. They perceived that a median of 37% of non-visit-specific AOV time substituted for visits, representing a potential five visits saved per day. They also perceived that 15% of total AOV time (excluding charting) could be performed by support staff. Forty-two percent of physicians indicated that one or more visits during the study day could be substituted for by AOVs.
CONCLUSIONS
Though time spent on AOVs is generally not reimbursed, primary care general internists spent significant time performing AOVs, much of which they perceived to substitute for visits that would otherwise have occurred. Policies supporting physician and staff time spent on AOVs may reduce health care costs, save time for patients and physicians, and improve care coordination.
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Acknowledgments
The authors thank participating physicians for their time, Dr. Martin Wells for his statistical advice, and Dr. Robert Amoruso for his support and assistance. Dr. Melinda A. Chen was a Fellow in Clinical Epidemiology and Health Services Research supported by grant number 5 T32 HS000066 from the Agency for Healthcare Research and Quality during the period in which this work was conducted. This work was presented at the Annual National Research Service Award Trainees Research Conferences on June 27, 2009 and June 26, 2010.
Conflict Of Interest
None disclosed.
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APPENDIX
APPENDIX
Categories of AOVs by Activity
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(1)
Charting in patient’s medical record
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(2)
Follow-up of patient information:
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A.
Diagnostic laboratory and imaging studies
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B.
Consult letters
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C.
Patient-related mail
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D.
Review of patient’s chart
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E.
Health information research pertaining to specific patient
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A.
-
(3)
Communication with staff and providers (care coordination discussions in person or via telephone)
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(4)
Communication with patients (via telephone or written messages)
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(5)
Patient-related process work
-
A.
Forms
-
B.
Scheduling
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C.
Insurance issues
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D.
Getting supplies
-
A.
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(6)
Orders
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A.
Medications
-
B.
Consults
-
C.
Diagnostic laboratory and imaging studies
-
A.
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Chen, M.A., Hollenberg, J.P., Michelen, W. et al. Patient Care Outside of Office Visits: A Primary Care Physician Time Study. J GEN INTERN MED 26, 58–63 (2011). https://doi.org/10.1007/s11606-010-1494-7
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DOI: https://doi.org/10.1007/s11606-010-1494-7