Association of primary care visit length with outpatient utilization, continuity, and care processes

Abstract

Abstract Background Little is known about how variation in the scheduled length of primary care visits can impact patients’ patterns of health care utilization. Objective To evaluate how the scheduled length of in-person visits with primary care physicians (PCPs) was associated with PCP and patient characteristics, outpatient utilization, and preventive care receipt. Methods This retrospective cohort study examined data from a large American academic health system. PCP visit length template was defined as either 15- and 30-min scheduled appointments (i.e. 15/30), or 20- and 40-min scheduled appointments (i.e. 20/40). Results Of 222 included PCPs, 85 (38.3%) used the 15/30 template and 137 (61.7%) used the 20/40 template. The 15/30 group had higher proportions of male (49.4%, vs. 35.8% in the 20/40 group) and family medicine (37.6% vs. 21.2%) physicians. In adjusted patient-level analysis (N = 238,806), having a 15/30 PCP was associated with 9% more primary care visits (incidence rate ratio [IRR], 1.09; 95% confidence interval [CI], 1.03–1.14), and 8% fewer specialty care visits (IRR, 0.92; 95% CI, 0.86–0.98). PCP visit length template was not associated with significant differences in obstetrics/gynaecology visits, continuity of care, or preventive care receipt. In interaction analyses, having a 15/30 PCP was associated with additional primary care visits among non-Hispanic White patients (IRR, 1.10; 95% CI, 1.04–1.16) but not among non-Hispanic Black patients. Conclusion PCPs’ choices about the scheduled length of in-person visits may impact their patients’ specialty care use, and have varying impacts across different racial/ethnic groups.