Although primary care consultation length varied internationally, the average duration was 5 minutes or less in approximately half of the world’s population, according to research published in BMJ Open.
“Primary care–driven health systems are effective at reducing disease, mortality and promoting a more equitable distribution of health worldwide,” Greg Irving, PhD, from the primary care unit at the University of Cambridge, U.K., and colleagues wrote. “As the global population increases, the demand for primary care is also growing ... This is leading to an array of different consultation lengths, with concerns among primary care physicians worldwide about the impact of shorter consultations.”
Irving and colleagues performed a systematic review of 178 studies that investigated PCP consultation lengths to determine the average length of consultations across economically developed and low- and middle-income countries. The studies, published between 1946 and 2016, covered more than 28.5 million consultations in 67 countries.
Data indicated that there was a wide variation in the average length of PCP consultation worldwide. Consultation time ranged from 48 seconds in Bangladesh to 22.5 minutes in Sweden. Consultations lasted 5 minutes or less in 18 countries that represented approximately half of the global population.
“Little can be achieved in less than 5 minutes unless the focus is largely on the detection and management of gross disease,” Irving and colleagues wrote. “An average of 5 minutes may be the limit below which consultations amount to little more than triage and the issue of prescriptions.”
Furthermore, the disparity in consultation length appears to be increasing. Researchers found a steady increase in average consultation length in developed countries, with only the United States, United Kingdom and Australia having sufficient data to show long-term trends. In the United States, the average time increased by 12 seconds per year, from 15.56 minutes in 1993 to 21.07 minutes in 2012. In the United Kingdom, the average time increased by 4.2 seconds per year, from 5 minutes in 1952 to 9.22 minutes in 2014. The average consultation length stayed relatively stable in Australia.
Conversely, in some low- and middle-income countries, consultation length appeared to decline over time.
Consultation length was significantly associated with health care spending per capita, admissions to hospital with ambulatory sensitive conditions such as diabetes, the number of PCPs per 1,000 of the population, physician efficiency, physician burnout and satisfaction. Consultation length was not associated with the amount of consultations patients received in a year, the number of diagnostic tests PCPs requested, the number of ED visits or patient satisfaction.
In addition, shorter consultation time increased the risk for polypharmacy, antibiotic overuse and poor communication with patients.
“There 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,” Irving and colleagues concluded. “Such a short consultation length is likely to adversely affect patient health care and physician workload and stress.” – by Alaina Tedesco
The authors report no relevant financial disclosures.