How many minutes should be reserved per patient in ambulatory care visits?

Abstract

This report was prepared aiming to review national and international literature about outpatient visit length with leading consequences, as well as to stimulate an evidence based discussion on this topic in Turkey. The relevant literature was investigated under three topics: First topic was about the length of outpatient visits in different countries, the second topic was about quality of care. The last topic was related with the effects of time pressure on health care providers such as efficiency, job satisfaction and patient satisfaction. International literature showed that outpatient visit length should not be less than 10 minutes and in complex situations this span should be expanded.

Keywords

• Outpatient care,visit length,quality of care

Ayaktan tanı ve tedavi başvurularında hasta başına kaç dakika ayrılmalıdır?

Abstract

Bu yazı, ayaktan tanı ve tedavi başvurularına ayrılan süreler ve bunun yol açtığı sonuçlar konusunda ulusal ve uluslararası düzeydeki bilgi birikimini derlemek ve ülkemizdeki ayaktan başvuru süreleri ile ilgili tartışmanın daha nesnel kanıtlar üzerinden yapılmasına olanak tanımak amacıyla hazırlanmıştır. Derlemede kaynaklar üç temel başlık altında incelenmiştir: İlk olarak birinci basamak sağlık hizmetlerindeki ayaktan tanı ve tedavi hizmetlerinde çeşitli ülkelerde, başvuru başına ayrılan süreler irdelenmiştir. İkinci başlık altında hizmet sunumunda ortaya çıkan nitel sorunlar incelenmiştir. Üçüncü başlık altında hekimler üzerindeki zaman baskısının, hekimlerin iş verimliliği, iş doyumu ve hasta hoşnutluğu üzerinde yol açtığı sonuçlar incelenmiştir. Uluslararası kaynaklara göre değerlendirildiğinde ayaktan başvuru sürelerinin 10 dakikadan az olmaması gerektiğini, ancak karmaşık tıbbi durumlar göz önüne alındığında bu sürenin daha da artması gerektiği sonucuna varılabilir. 

Keywords

• Tanı-tedavi,muayene süresi,sağlık bakım kalitesi

References

1. 1. Türk Tabipleri Birliği. TTB 2014-16 Yıllık Çalışma Raporu. 2016.
2. 2. T24 İnternet Haber Gazetesi. 'Doktorlar hastalara 5 dakika ayırarak günde 150 hasta bakmak zorunda bırakılıyor'. 2013; http://t24.com.tr/haber/doktorlarhastalara-5-dakika-ayirarak-gunde- 150-hasta-bakmak-zorundabirakiliyor,245512. Erişim Tarihi 20 Şubat, 2017.
3. 3. Medimagazin. Bakanlıktan 5 dakika açıklaması. . 2016; http://www.medimagazin.com.tr/he kim/saglik-bak/tr-bakanliktan-5- dakika-aciklamasi-2-13-72058.html Erişim Tarihi 20 Şubat, 2017.
4. 4. Doktorlar Sitesi. Kamuoyuna Sorduk “Bİr Hekİm Bİr Hastaya Ortalama Kaç Dk. Ayirmalidir?” İşte Cevaplar. 2015; http://doktorlarsitesi.net/2015/07/ 13/kamuoyuna-sorduk-bir-hekimbir-hastaya-ortalama-kac-dkayirmalidir-iste-cevaplar/. Erişim Tarihi 20 Şubat, 2017.
5. 5. Davidoff F. Time. Ann Intern Med. 1997;127(6):483-485.
6. 6. Camasso MJ, Camasso AE. Practitioner productivity and the product content of medical care in publicly supported health centers. Soc Sci Med. 1994;38(5):733-748.
7. 7. Landau DA, Bachner YG, Elishkewitz K, Goldstein L, Barneboim E. Patients' views on optimal visit length in primary care. J Med Pract Manage. 2007;23(1):12-15.
8. 8. Tai-Seale M, McGuire TG, Zhang W. Time allocation in primary care office visits. Health Serv Res. 2007;42(5):1871-1894.

9. 9. Ashman JJ, Hing E, Talwalkar A, National Ambulatory Medical Care Survey (U.S.), National Center for Health Statistics (U.S.). Variation in physician office visit rates by patient characteristics and state, 2012. NCHS data brief no 212. Hyattsville, Md.: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics,; 2015.
10. 10. Peckham C. Medscape Physician Compensation Report. 2016; http://www.medscape.com/features /slideshow/compensation/2016/pu blic/overview?src=wnl_physrep_160 401_mscpedit&uac=232148CZ&impI D=1045700&faf=1#page=26. Erişim Tarihi 20 Şubat, 2017.
11. 11. Chen LM, Farwell WR, Jha AK. Primary care visit duration and quality: does good care take longer? Arch Intern Med. 2009;169(20):1866- 1872.
12. 12. Deveugele M, Derese A, van den Brink-Muinen A, Bensing J, De Maeseneer J. Consultation length in general practice: cross sectional study in six European countries. BMJ. 2002;325(7362):472.
13. 13. Andersson SO, Mattsson B. Length of consultations in general practice in Sweden: views of doctors and patients. Fam Pract. 1989;6(2):130- 134.
14. 14. Ohtaki S, Ohtaki T, Fetters MD. Doctor-patient communication: a comparison of the USA and Japan. Fam Pract. 2003;20(3):276-282.
15. 15. Ishikawa H, Hashimoto H, Roter DL, Yamazaki Y, Takayama T, Yano E. Patient contribution to the medical dialogue and perceived patient centeredness. An observational study in Japanese geriatric consultations. J Gen Intern Med. 2005;20(10):906- 910.
16. 16. Wooldridge AN, Arato N, Sen A, Amenomori M, Fetters MD. Truth or fallacy? Three hour wait for three minutes with the doctor: Findings from a private clinic in rural Japan. Asia Pac Fam Med. 2010;9(1):11.
17. 17. Konrad TR, Link CL, Shackelton RJ, et al. It's about time: physicians' perceptions of time constraints in primary care medical practice in three national healthcare systems. Med Care. 2010;48(2):95-100.
18. 18. Information Centre Part of the Government Statistical Service. 2006/07 UK General Practice Workload Survey 2007; http://content.digital.nhs.uk/catalog ue/PUB01028/gp-work-serv-rep.pdf. Erişim Tarihi 9, 12, 2016.
19. 19. WHO. Evaluation of the organization and the provision of primary care in Serbia. 2016; http://www.euro.who.int/__data/ass ets/pdf_file/0005/128849/e94554.p df. Erişim Tarihi 20 Şubat, 2017.
20. 20. Guldal D, Ulusel B, Ozcakar N, Yeniceri N, Dontlu C. The challenge of clinical interviewing and physical examination performance for general practitioners in Turkey. Fam Med 2005;37(5):354-359.
21. 21. Lowes RL. Are you expected to see too many patients? Med Econ. 1995;72(6):52-53, 57-59.
22. 22. Morrell DC, Evans ME, Morris RW, Roland MO. The "five minute" consultation: effect of time constraint on clinical content and patient satisfaction. Br Med J (Clin Res Ed). 1986;292(6524):870-873.
23. 23. Roland MO, Bartholomew J, Courtenay MJ, Morris RW, Morrell DC. The "five minute" consultation: effect of time constraint on verbal communication. Br Med J (Clin Res Ed). 1986;292(6524):874-876.
24. 24. Wilson A, McDonald P, Hayes L, Cooney J. Health promotion in the general practice consultation: a minute makes a difference. BMJ. 1992;304(6821):227-230.
25. 25. Lafata JE, Shay LA, Brown R, Street RL. Office-Based Tools and Primary Care Visit Communication, Length, and Preventive Service Delivery. Health Serv Res 2016;51(2):728-745.
26. 26. Kaplan SH, Greenfield S, Gandek B, Rogers WH, Ware JE, Jr. Characteristics of physicians with participatory decision-making styles. Ann Intern Med. 1996;124(5):497- 504.
27. 27. Hickson GB, Clayton EW, Entman SS, et al. Obstetricians' prior malpractice experience and patients' satisfaction with care. JAMA. 1994;272(20):1583- 1587.
28. 28. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physicianpatient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277(7):553- 559.
29. 29. Lin CT, Albertson GA, Schilling LM, et al. Is patients' perception of time spent with the physician a determinant of ambulatory patient satisfaction? Arch Intern Med 2001;161(11):1437-1442.
30. 30. Dugdale DC, Epstein R, Pantilat SZ. Time and the patient-physician relationship. J Gen Intern Med. 1999;14 Suppl 1:S34-40.
31. 31. Ridsdale L, Carruthers M, Morris R, Ridsdale J. Study of the effect of time availability on the consultation. J R Coll Gen Pract. 1989;39(329):488- 491.
32. 32. Beisecker AE, Beisecker TD. Patient information-seeking behaviors when communicating with doctors. Med Care. 1990;28(1):19-28.
33. 33. Association BM. The future of General Practice. National survey of GPs 2015; https://www.bma.org.uk/collective-voice/committees/generalpractitioners-committee/gpcsurveys/future-of-general-practice. Erişim Tarihi 7 Aralık, 2016.
34. 34. Haroon Siddique. GP appointments should be five minutes longer, says BMA. 2016; https://www.theguardian.com/socie ty/2016/aug/28/doctorappointments-15-minutes-bmaoverweight-population. Erişim Tarihi 11, 12, 2016.
35. 35. Tabenkin H, Goodwin MA, Zyzanski SJ, Stange KC, Medalie JH. Gender differences in time spent during direct observation of doctor-patient encounters. J Womens Health (Larchmt). 2004;13(3):341-349.
36. 36. Fiscella K, Goodwin MA, Stange KC. Does patient educational level affect office visits to family physicians? J Natl Med Assoc 2002;94(3):157-165.
37. 37. Shaw MK, Davis SA, Fleischer AB, Feldman SR. The duration of office visits in the United States, 1993 to 2010. Am J Manag Care 2014;20(10):820-826.