Length of Pediatric Primary Care Visits Increases in the Past Decade

Olson, Lynn; Tang, Suk-fong S.; Cull, William L.

Institutions (All):

1. Research , American Academy of Pediatrics, Itasca, IL, United
2. Research, American Academy of Pediatrics, Itasca, IL, United
3. Research, American Academy of Pediatrics, Itasca, IL, United

Background: Multiple factors are shaping change in pediatric primary care practice in the US. One component integral to change may be duration of office visits, yet little has been documented on the trend in pediatric visit length.

Objective: Assess change in the length of primary care visits to pediatricians in the US from 2005 to 2015 and identify variations in length related to patient and visit characteristics.

Design/Methods: Nationally representative data from 2005-2015 of the National Ambulatory Medical Care Survey (NAMCS) were used to measure office-based primary care visits provided by pediatricians in private solo or group practice settings for patients age 0-21. Length of visit is based on physician report of time they spend with patient. Annual sample size ranged from 1,593 (2006) to 7,238 (2012); total sample=32,315. Patient visit sampling weights provided by NAMCS were applied. Multivariable general linear model was used to assess change in visit length, controlling for: Patient age, gender, geographic region and several measures of type of visit: whether referrals made, mental health diagnosis, # medications prescribed, # of chronic conditions. SPSS Complex Samples were used for all statistical analyses. Only results significant at p<.05 are reported.

Results: The average visit length increased steadily and significantly during the period, from 15.8 minutes in 2005 to 21.1 minutes in 2015 (see Figure with values and 95% CI). In the multivariable model (Wald F (19, 893) = 17.14, p <

.001), visit length increased with preventive visit (β=2.99), visit with one or more mental health diagnosis (β=3.70), visit with a referral made (β=2.28), # of medications (β=.25), and # of chronic conditions (β=.74). The increase over time in visit length remained significant (β=.46 for each year since 2005) after all other factors were included in the model.

Conclusion(s): There is a clear trend toward longer pediatric office visits in primary care, with the duration of time spent with the pediatrician increasing a relative 33% from 2005 to 2015. While financial pressures may create pressures for shorter visits, nationally this is not the trend. Other factors, such as more comprehensive preventive care being provided and diagnosis of mental health conditions, may lead to visits of greater duration.