Not enough time for primary care clinicians to provide guideline-recommended care, study finds
A recent simulation study estimated that a primary care clinician would require 26.7 h/d to provide preventive, chronic, and acute care, plus documentation/inbox management, to an average panel of 2,500 patients. This time decreased to 9.3 h/d with team-based care.
There's not enough time in a day for a primary care clinician to provide guideline-recommended care to adult patients, a recent study found.
Researchers conducted a simulation study that applied preventive and chronic disease care guidelines to hypothetical patient panels. They created 1,000 hypothetical panels of 2,500 patients from the 5,856 adult participants in the 2017-2018 National Health and Nutrition Examination Survey. For each panel, they used evidence from the literature to calculate the time needed for a primary care clinician to address preventive care, chronic disease care, acute care, and documentation/inbox management. Results were published July 1 by the Journal of General Internal Medicine.
For an average panel of 2,500 patients, the researchers estimated that a primary care clinician would require 26.7 h/d to provide preventive, chronic, and acute care with documentation/inbox management. Preventive care alone would require about 14.1 h/d, with preventive care task time ranging from less than 1 s/d (screening and counseling regarding medication use to reduce risk of breast cancer) to 4.1 h/d (counseling regarding weight loss to prevent obesity-related morbidity and mortality). Other time requirements were 7.2 h/d for chronic disease care, 3.2 h/d for acute care, and 3.2 h/d for documentation and inbox management. With a team-based care model, primary care clinicians would require an estimated 9.3 h/d: 2.0 h/d for preventive care, 3.6 h/d for chronic disease care, 1.1 h/d for acute care, and 2.6 h/d for documentation/inbox management.
Among other limitations, little evidence existed on the time needed to address each chronic disease at each visit, the study authors noted. They added that assuming different panel sizes resulted in proportional changes to the results but noted that even a 1,500-patient panel required 16 hours of a primary care clinician's time per day. “Under every scenario our conclusion was the same: providing ideal guideline-based preventive, chronic disease, and acute care services places an unreasonable time burden on a PCP that is only partially mitigated by team-based care models and smaller panel sizes,” the authors concluded.