Patient care outside of office visits: a primary care physician time study

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.

Figure 1

Recruitment and screening.

Figure 2

Percentage of time spent in AOVs by category (Charting. Follow-up of patient information (diagnostic studies, consults, mail, chart review, health research). Communication with staff and providers. Communication with patients (phone calls, answering messages). Patient-related process work (forms, scheduling, insurance issues, getting supplies). Orders (medications, consults, studies).