The Association Between Patient Complexity and Primary Care Visit Length and Composition

Abstract

Importance: Our research examines the duration and content of primary care visits with a focus on whether visit length or composition differs for highly complex patients as compared to non-complex patients. This comparison elucidates the potential for primary care practices to provide more appropriately tailored outpatient care to meet the needs of complicated patients.

Objective: We hypothesized that physician-defined complex patients would spend more time with their primary care physicians in each visit based on their increased medical, psychosocial, and mental health issues. With similar reasoning, we predicted that a physician-defined complex patient appointment would have different composition than a non-complex appointment.

Design, Setting and Participants: This study was a prospective cohort study conducted at a large hospital-based primary care practice at Massachusetts General Hospital. Seven volunteer primary care physicians were recruited and data was collected from a total of 635 visits.

Results: The study results regarding total visit length revealed that physician-defined complex patients and non-complex patients spend the same amount of time in any given primary care appointment. We also found that visit composition differs significantly between physician-defined complex and non-complex groups.

Conclusion and Relevance: The study results regarding visit length showed that physician-defined complex patients and their non-complex counterparts spend the same amount of time in a single medical appointment. Within this standard visit length, we found that visit composition differs significantly between the patient groups. In complex visits, more time is spent discussing medications, specialty care coordination, and mental health. These patients receive less time on education, care planning, screening guidelines, logistics, and social discourse. These differences raise questions about whether standard visit length provides adequate time for patients with increased medical needs. Given that physician-defined complex patients struggle with relatively compromised health outcomes, these patients likely need more, not less, emphasis on the elements currently lacking in their care. Though complex patients have a greater number of appointments over time, less focus on the same subset of topics in each visit may ultimately compromise care in those areas. Thus complex patients may benefit from standardized supplemental care tailored to meet their advanced needs.