Revisiting the Time Needed to Provide Adult Primary Care

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. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-022-07707-x.

Primary Care Provider HIV PrEP Knowledge, Attitudes, and Prescribing Habits: A Cross-Sectional Survey of Late Adopters in Rural and Suburban Practice

“…Our study uniquely identified an electronic medical record order set as the number one facilitator for PrEP prescribing by respondents, which may indicate the need to develop system-based practice solutions targeted at infrequent prescribers of PrEP, which is consistent with a systemic review of barriers to PrEP prescribing and found the need to better optimize PrEP delivery. 13 While evidence-based policy statements from the USPSTF and CDC have been clear about the benefits of PrEP, primary care providers do not have sufficient time with patients to address all the current preventative health recommendations, 34 making it crucial to look at processes that streamline PrEP initiation and maintenance. Avery et al found that implementing an electronic medical record-based reminder effectively increased HIV screening among primary care patients, while education and practice feedback alone did not.…”

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“…4 However, clinicians commonly cite lack of time as a barrier, making shared decisionmaking another good candidate for use of freed time from not obtaining a full ROS. Although not all preventive care need be done by clinicians during patient encounters-other health care team members 5 or population managers 6 could deliver many preventive services-engaging in shared decision-making with patients to make good preventive care decisions is a highly worthwhile use of limited clinician time.…”