Is the duration of skin disease visits decreasing in the united states?

摘要

Background: Changes in the practice of medicine may be affecting how much time physicians spend with their patients.? Economic pressures in some health systems may limit how much time patients spend with doctors.? Inefficiencies associated with the use of EMR potentially could lengthen the duration of office visits. Objective: To assess trends in the duration of skin disease visits over the last two decades. Methods: Skin disease visits were selected from the 1993-2010 National Ambulatory Medical Care Survey. Changes in overall number of visits per dermatologist, variation in visit duration, and differences by specialty in visit duration were assessed. Results: The mean duration of skin disease visits increased over time for both dermatologists (β=0.24 minutes) and nondermatologists (β=0.19, both P0.0001). For visits with a sole diagnosis of skin disease, dermatologist visits were shorter (14.7 minutes) than nondermatologist visits (16.4 minutes, P0.0001). Visits for unspecified warts, atopic dermatitis, unspecified dermatitis, and acne grew significantly longer over time. In a multivariate analysis, older age, later year, nondermatology specialty, new patient status, procedure performed, private insurance, no physician extender involvement, and electronic medical records were associated with longer visit duration. Limitations: The data are not informative about the quality of the time physicians spend with patients. Conclusions: Economic pressures have, so far, not reduced the average time physicians spend in direct contact with patients.