Patients of color and patients with public health insurance, such as Medicaid or Medicare, receive less face-to-face time when visiting their primary care physician, according to a recent study published in JAMA Health Forum.
Minimal face time with physicians can lead to dangerous consequences for patients, including worsening conditions and inappropriate prescriptions.
For this study, researchers analyzed electronic health records from more than 8 million visits to more than 8,000 primary care doctors across the United States in 2017. In total, about 4.3 million adult patients were involved, of whom 68% were white, 10% were Black and 8% were Latino.
Study author Hannah Neprash, PhD, an assistant professor at the University of Minnesota’s School of Public Health, and her team found that the average primary care visit lasts about 18 minutes. Neprash noted that prior research suggests that a primary care doctor would require about 27 hours to provide all the adequate and critical information needed to prevent chronic illness as well as address a patient’s unique issues.
After analyzing time stamps, Neprash told HealthDay that “visit length varies by a lot of the characteristics one might expect. For example, visits with more diagnoses, topics or concerns are longer, [and] visits for new patients are longer than visits for established patients.”
Patient race or ethnicity, age and insurance type played a role as well. Neprash noted that patients of color and those with public health insurance experienced shorter visits. Younger patients were also more likely to have shorter visits.
Patients with public insurance or no insurance experienced significantly shorter visits, while Black and Latino patients saw their primary care doctors 30 to 60 seconds less on average than white patients with better health insurance coverage.
Neprash emphasized that these differences “can add up, especially when the average primary care visit is only a bit longer than 15 minutes.”
To look at specific cases within the cohort, researchers focused on three subsets of patients, which included about 223,000 visits involving an upper respiratory tract infection diagnosis, about 1.6 million visits that resulted in a pain-related diagnosis and more than 2.75 million visits from seniors.
For patients with an upper respiratory tract infection, nearly 56% of visits resulted in an inappropriate antibiotic prescription. About 3.4% of pain-related visits ended in a dangerous and potentially lethal combination of two opposing prescription medications—an opioid painkiller and a benzodiazepine sedative, such as Xanax or Valium. Among seniors, just over 1% of visitors were prescribed medications that do not comply with public health guidelines.
Neprash’s team noted that the risk for receiving an inappropriate prescription increased as the doctor visit got shorter.