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Length of Pediatric Visits Actually Increasing

Alicia Merline, Lynn Olson, William Cull.. Department of Research, American Academy of Pediatrics, Elk Grove Village, IL.

Presented at the May 2009 Pediatric Academic Societies Annual Meeting.

Background: While length of pediatric visits to primary care doctors increased between 1979 and 1994, increasing productivity demands on primary care providers have led many doctors to feel that insufficient time is available during visits.
 
Objective: Investigate changes in the length of pediatric office visits to primary care doctors from 1994 to 2006 and to identify variations in visit length related to visit characteristics.
 
Design/Methods: Nationally representative data from the National Ambulatory Medical Care Survey (NAMCS) from 1994-2006 were used to select visits to primary care physicians (General Practitioners, Family Physicians, Pediatricians and Adolescent Medicine) by patients birth to age 17. The number of visits per year ranged from 1,893 (1999) to 3,657 (2002) resulting in a total sample size of 34,074 visits. Multivariate regressions were performed to investigate change in visit length while controlling for visit characteristics (patient age, patient race, insurance type, health supervision visit and physician's specialty).
 
Results: Average visit length increased 14% from 1994 (14.2 min) to 2006 (16.4 min). The increase was consistent and widespread; visit length increased for all racial/ethnic groups, all age groups and for both pediatricians and other primary care doctors. The length of visits also varied on other key dimensions. In 2006, the average health supervision visit was 18.2 min versus 14.4 min for all other visits, and visit length increased with child age, ranging from 14.6 min (0 to 5 yrs) to 15.4 min (13 to 17 yrs). When visit characteristics were controlled within a multivariate model, the increase in visit length across time remained significant (B = 0.14, 95% CI = 0.12, 0.17).
 
Conclusions: Contrary to the time crunch that many primary care providers report, the actual length of pediatric primary care visits has continued to increase. The feeling of insufficient time may be a reflection of additional time available during visits not keeping pace with additional expectations of providers during visits.
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