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. 2023 Jan;38(1):147-155.
doi: 10.1007/s11606-022-07707-x. Epub 2022 Jul 1.

Revisiting the Time Needed to Provide Adult Primary Care

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Revisiting the Time Needed to Provide Adult Primary Care

Justin Porter et al. J Gen Intern Med. 2023 Jan.

Abstract

Background: Many patients do not receive guideline-recommended preventive, chronic disease, and acute care. One potential explanation is insufficient time for primary care providers (PCPs) to provide care.

Objective: To quantify the time needed to provide 2020 preventive care, chronic disease care, and acute care for a nationally representative adult patient panel by a PCP alone, and by a PCP as part of a team-based care model.

Design: Simulation study applying preventive and chronic disease care guidelines to hypothetical patient panels.

Participants: Hypothetical panels of 2500 patients, representative of the adult US population based on the 2017-2018 National Health and Nutrition Examination Survey.

Main measures: The mean time required for a PCP to provide guideline-recommended preventive, chronic disease and acute care to the hypothetical patient panels. Estimates were also calculated for visit documentation time and electronic inbox management time. Times were re-estimated in the setting of team-based care.

Key results: PCPs were estimated to require 26.7 h/day, comprising of 14.1 h/day for preventive care, 7.2 h/day for chronic disease care, 2.2 h/day for acute care, and 3.2 h/day for documentation and inbox management. With team-based care, PCPs were estimated to require 9.3 h per day (2.0 h/day for preventive care and 3.6 h/day for chronic disease care, 1.1 h/day for acute care, and 2.6 h/day for documentation and inbox management).

Conclusions: PCPs do not have enough time to provide the guideline-recommended primary care. With team-based care the time requirements would decrease by over half, but still be excessive.

Keywords: Chronic disease care; Population health; Preventive care; Primary care; Team-based care.

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Conflict of interest statement

Cynthia Boyd: Dr. Boyd was funded by NIA K24AG056578.

Neda Laiteerapong: Dr. Laiteerapong was funded by NIDDK P30 DK092949.

Justin Porter: None

M. Reza Skandari: None

Figures

Fig. 1
Fig. 1
Schematic displaying the creation of patient panels from an NHANES cohort, and the calculation of annual PCP preventive and chronic disease care time
Fig. 2
Fig. 2
Primary care provider time needed to provide care for average US adult panel of 2500 patients.
Fig. 3
Fig. 3
Additional preventive care time shifted to non-PCP team members in a team-based care model. Abbreviations: RN, registered nurse; LPN, licensed practical nurse; MA, medical assistant.
Fig. 4
Fig. 4
Sensitivity/scenario analyses: change in PCP time with PCP-only care. Abbreviations: PCP, primary care provider.
Fig. 5
Fig. 5
Sensitivity/scenario analyses: percent change in PCP time with team-based care. Abbreviations: PCP, primary care provider.

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