Article Text

International variations in primary care physician consultation time: a systematic review of 67 countries
  1. Greg Irving1,
  2. Ana Luisa Neves2,3,
  3. Hajira Dambha-Miller1,4,
  4. Ai Oishi5,
  5. Hiroko Tagashira6,
  6. Anistasiya Verho7,8,
  7. John Holden9
  1. 1 Primary Care Unit, University of Cambridge, Cambridge, UK
  2. 2 Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto, Porto, Portugal
  3. 3 Centre for Health Policy, Institute Global Health Innovation, Imperial College London, London, UK
  4. 4 Nuffield Department of Primary Care Health Sciences, University of Oxford
  5. 5 The Usher Institute of Population Health and Informatics, University of Edinburgh, Edinburgh, UK
  6. 6 Horton General Hospital, Banbury, UK
  7. 7 The University of Helsinki, Finland
  8. 8 National Institutefor Health and Welfare (THL)
  9. 9 Garswood Surgery, Wigan, UK
  1. Correspondence to Dr Greg Irving; gi226{at}cam.ac.uk

Abstract

Objective To describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes.

Design and outcome measures This is a systematic review of published and grey literature in English, Chinese, Japanese, Spanish, Portuguese and Russian languages from 1946 to 2016, for articles reporting on primary care physician consultation lengths. Data were extracted and analysed for quality, and linear regression models were constructed to examine the relationship between consultation length and health service outcomes.

Results One hundred and seventy nine studies were identified from 111 publications covering 28 570 712 consultations in 67 countries. Average consultation length differed across the world, ranging from 48 s in Bangladesh to 22.5 min in Sweden. We found that 18 countries representing about 50% of the global population spend 5 min or less with their primary care physicians. We also found significant associations between consultation length and healthcare spending per capita, admissions to hospital with ambulatory sensitive conditions such as diabetes, primary care physician density, physician efficiency and physician satisfaction.

Conclusion 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. Such a short consultation length is likely to adversely affect patient healthcare and physician workload and stress.

  • primary care
  • consultation
  • global health

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors GI designed the review, extracted data, wrote the protocol, conducted the analysis, and drafted and revised the paper. ALN extracted data, and drafted and revised the paper. HD-M revised the paper. AO extracted data. HT extracted data. AV extracted data. JH designed the review, and drafted and revised the paper. GI is guarantor.

  • Funding GI is an NIHR Clinical Lecturer and HDM is an NIHR Doctoral Research Fellow who are funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. However, this research received no specific grant from any funding agency in the public,commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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