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October 11, 2022
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Q&A: PCPs lack time needed to perform guideline-based care

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Primary care providers do not have enough time to provide guideline-recommended acute, preventive and chronic disease care, according to a recent study published in the Journal of General Internal Medicine.

“These findings explain why improvements in the quality of primary care have eluded the USA for the last 2 decades,” Justin Porter, MD, an assistant professor of medicine at the University of Chicago Medicine, and colleagues wrote.

PC0922Porter_Graphic_01_WEB

Using a hypothetical panel of 2,500 patients representative of the U.S. adult population, the researchers found that PCPs need an estimated 26.7 hours per day to provide recommended care:

  • 14.7 hours for preventive care;
  • 7.2 hours for chronic disease care; and
  • 3.4 hours for documentation and inbox management.

Porter and colleagues also examined the amount of time needed in a team-based model scenario, in which traditional tasks would be shifted to other health care providers.

In the team-based model, PCPs required an estimated 9.3 hours per day to deliver guideline-recommended care.

“Theoretically, the time savings may allow PCPs to focus on more advanced care, see more patients, or increase the delivery of guideline-based care,” they wrote.

However, the researchers said that while the model cuts the time requirements by over half, they would “still be excessive.”

Porter spoke to Healio to discuss some of the study’s more noteworthy findings, factors that prevent PCPs from being able to provide guideline-recommended care, and more.

Healio: Did the findings surprise you?

Porter: The 26.7 hours per day is obviously a completely infeasible number, so the headline number is certainly surprising. Within that, there are a lot of interesting pieces of information.

One of the [factors] driving that number is the amount of time it takes to do counseling services. We're talking about [services] like dietary counseling for patients with obesity or patients with diabetes. Those things take a lot more time than I think a lot of people thought. Although those services take a lot of time, the data behind that time requirement is quite strong.

Meta-analyses in the past that have been done by the U.S. Federal Services Task Force [have] showed the time that we've cited is the minimum amount of time that it would take to result in changes in outcomes for patients.

So, while doctors could spend less time than that, they would be unlikely to get the results that we're looking for. I think this exposes the difference between doing a preventive service adequately and with the guidelines, versus how we probably do it in practice.

Healio: Other than time restrictions, are there any other factors that influence the inability to meet recommendations?

Porter: Beyond the requirements for doctors, the way we finance health care and how we compensate physicians plays a role. The second part of our study was trying to see how a perfectly functioning team-based care model might save physicians time. Although it did save a large chunk of time, it’s an open question on how generalizable that type of model would be, simply because we currently lack a lot of the funding mechanisms to support models like that.

Healio: Your study has seen an increase in attention on social media. Why is that, and do you think it will help prompt further research or advocacy on the topic?

Porter: When I was doing this study, and I would talk about it with other physicians, I certainly knew that this was something physicians were interested in, because I think it speaks to their lived experience.

What I’ve seen since we’ve published is that there seems to be a lot of interest even outside of physicians. I think it speaks to patients in the same way. As a patient, one might have felt the other side of this, they might have felt their physician wasn’t providing the care they wish they did. That’s probably what's resulted in a lot of the attention that it's gotten.

I think the fact that it’s causing this discussion, I would hope it would draw more research into this area. These types of studies help the larger health care community to understand the pressure that physicians are under.

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