Visit duration of office-based ophthalmology visits in a nationally representative sample

Abstract

Purpose: To assess the mean visit duration of office-based ophthalmology visits in the United States. Methods: The National Ambulatory Medical Care Survey (NAMCS) was queried to identify visits conducted by ophthalmologists between years 2006-2016. Primary outcome measure was the time spent with the ophthalmologist (in minutes). Demographic and health information including patient age, sex, race/ethnicity, insurance type, and number of chronic conditions were assessed. Reason for visit, new patient status, number of medications prescribed, electronic medical record use, regional location, and metropolitan status of each visit were also collected. International Classification of Diseases Clinical Modification Ninth and Tenth Revision codes (ICD-9-CM and ICD-10-CM) were used to categorize each visit by subspecialty of primary diagnosis (i.e. cataract, cornea/refractive, glaucoma, oculoplastic, perioperative, and retina). Univariate and multivariate ordinary least square linear regression analyses were used to determine predictors of visit duration. Results: Between 2006-2016, there was an annual average of 52 million ophthalmology office-based visits. Mean visit duration [standard error] was 20.7 [0.4] minutes, annually. An increase in visit duration was observed with a mean of 19.1 [1.5] minutes in 2006 and a mean of 22.5 [1.2] minutes in 2016. The five strongest predictors of visit duration were Medicaid insurance (ß [regression coefficient] 5.1; 95% CI [confidence interval] 1.39-8.74), new patient status (ß 2.7; 95% CI 1.55-3.79), new medications (ß 1.1; 95% CI 0.32-1.92), year of visit (ß 0.7; 95% CI 0.48-0.93), and non-metropolitan location (ß -2.8; 95% CI -4.45- (-1.20)) (all p<0.01). Conclusion: Across 11 years, mean visit duration of office-based ophthalmology visits has increased. Predictors of visit duration reflect healthcare utilization patterns in low-resource populations, provider-patient encounters, a growing aging population, and a shortage of ophthalmologists in rural areas. As interventions are made to better model and improve the clinic experience of ophthalmic patients, these factors should be considered.