International variations in primary care physician consultation time: a systematic review of 67 countries

Abstract

ObjectiveTo describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes.Design and outcome measuresThis is a systematic review of published and grey literature in English, Chinese, Japanese, Spanish, Portuguese and Russian languages from 1946 to 2016, for articles reporting on primary care physician consultation lengths. Data were extracted and analysed for quality, and linear regression models were constructed to examine the relationship between consultation length and health service outcomes.ResultsOne hundred and seventy nine studies were identified from 111 publications covering 28 570 712 consultations in 67 countries. Average consultation length differed across the world, ranging from 48 s in Bangladesh to 22.5 min in Sweden. We found that 18 countries representing about 50% of the global population spend 5 min or less with their primary care physicians. We also found significant associations between consultation length and healthcare spending per capita, admissions to hospital with ambulatory sensitive conditions such as diabetes, primary care physician density, physician efficiency and physician satisfaction.ConclusionThere are international variations in consultation length, and it is concerning that a large proportion of the global population have only a few minutes with their primary care physicians. Such a short consultation length is likely to adversely affect patient healthcare and physician workload and stress.

A Brief Questionnaire to Assess Post-Exertional Malaise

“…Therefore, PEM duration, in which exertion has prolonged effects, occurs more often and with greater duration among those with ME and CFS relative to MS and PPS. Because these additional DSQ PEM duration items can help differentiate ME and CFS from those with at least two other chronic conditions, these items might have appeal to clinicians who often have limited periods of time to make these types of diagnostic decisions [17]. PEM duration criterion as lasting 14–23 h after exertion, or 24 h or more after exertion, differentiates those with ME and CFS from MS and PPS (see Table 3).…”

“…While this method has high validity and reliability [23], cardiopulmonary exercise testing for patients with ME and CFS is not covered by insurance [24], and standard testing ranges from $165 to $350, while more complex cardiopulmonary exercise tests can cost up to $1605 [25]. Therefore, self-reporting data has certain advantages in terms of expense to patients with ME and CFS due not only to costs, but also to the time constraints placed on physicians to make an expedient diagnosis [17]. However, if patients with ME and CFS have greater access to medical care due to a lower financial entry barrier, then the choice of metric is in favor of the Cardiopulmonary Exercise Stress Test (CPET).…”

GP appointments last less than five minutes for half the world’s population

“…The research,1 published in BMJ Open , reveals wide variation in the average consultation length across the globe, with examples ranging from just 48 seconds in Bangladesh to 22.5 minutes in Sweden.…”

Is evidence‐based medicine a mirage in resource‐constrained settings? A survey among resident doctors in selected teaching hospitals in Nigeria

“…Apart from knowledge, clinicians do also face other barriers in adopting the EBM concepts, the most consistently documented of which is the lack of time to search for, retrieve and study evidence each time a clinical question is raised 7‐12 . The time barrier and similar challenges are probably of higher relevance in resource‐constraint settings like Nigeria with a low doctor‐population ratio of 4 in 10 000, 13 and an average consultation time of 10 minutes or less 14 …”