Time Pressure During Primary Care Office Visits: a Prospective Evaluation of Data from the Healthy Work Place Study.

Female Humans Job Satisfaction Male Office Visits Primary Health Care Prospective Studies Workplace
health services research medical culture physician satisfaction primary care time pressure workforce

Journal

Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834

Informations de publication

Date de publication:
02 2020
Historique:
received: 30 11 2018
accepted: 28 08 2019
revised: 10 07 2019
pubmed: 5 12 2019
medline: 15 5 2021
entrez: 5 12 2019
Statut: ppublish

Résumé

The relationship between worklife factors, clinician outcomes, and time pressure during office visits is unclear. To quantify associations between time pressure, workplace characteristics ,and clinician outcomes. Prospective analysis of data from the Healthy Work Place randomized trial. 168 physicians and advanced practice clinicians in 34 primary care practices in Upper Midwest and East Coast. Time pressure was present when clinicians needed more time than allotted to provide quality care. Other metrics included work control, work pace (calm to chaotic), organizational culture and clinician satisfaction, stress, burnout, and intent to leave the practice. Hierarchical analysis assessed relationships between time pressure, organizational characteristics, and clinician outcomes. Adjusted differences between clinicians with and without time pressure were expressed as effect sizes (ESs). Sixty-seven percent of clinicians needed more time for new patients and 53% needed additional time for follow-up appointments. Time pressure in new patient visits was more prevalent in general internists than in family physicians (74% vs 55%, p < 0.05), women versus men (78% vs 55%, p < 0.01), and clinicians with larger numbers of complex psychosocial (81% vs 59%, p < 0.01) and Limited English Proficiency patients (95% vs 57%, p < 0.001). Time pressure in new patient visits was associated with lack of control, clinician stress, and intent to leave (ESs small to moderate, p < 0.05). Time pressure in follow-up visits was associated with chaotic workplaces and burnout (small to moderate ESs, p's < 0.05). Time pressure improved over time in workplaces with values alignment and an emphasis on quality. Time pressure, more common in women and general internists, was related to chaos, control and culture, and stress, burnout, and intent to leave. Future studies should evaluate these findings in larger and more geographically diverse samples.

Sections du résumé

BACKGROUND
The relationship between worklife factors, clinician outcomes, and time pressure during office visits is unclear.
OBJECTIVE
To quantify associations between time pressure, workplace characteristics ,and clinician outcomes.
DESIGN
Prospective analysis of data from the Healthy Work Place randomized trial.
PARTICIPANTS
168 physicians and advanced practice clinicians in 34 primary care practices in Upper Midwest and East Coast.
MAIN MEASURES AND METHODS
Time pressure was present when clinicians needed more time than allotted to provide quality care. Other metrics included work control, work pace (calm to chaotic), organizational culture and clinician satisfaction, stress, burnout, and intent to leave the practice. Hierarchical analysis assessed relationships between time pressure, organizational characteristics, and clinician outcomes. Adjusted differences between clinicians with and without time pressure were expressed as effect sizes (ESs).
KEY RESULTS
Sixty-seven percent of clinicians needed more time for new patients and 53% needed additional time for follow-up appointments. Time pressure in new patient visits was more prevalent in general internists than in family physicians (74% vs 55%, p < 0.05), women versus men (78% vs 55%, p < 0.01), and clinicians with larger numbers of complex psychosocial (81% vs 59%, p < 0.01) and Limited English Proficiency patients (95% vs 57%, p < 0.001). Time pressure in new patient visits was associated with lack of control, clinician stress, and intent to leave (ESs small to moderate, p < 0.05). Time pressure in follow-up visits was associated with chaotic workplaces and burnout (small to moderate ESs, p's < 0.05). Time pressure improved over time in workplaces with values alignment and an emphasis on quality.
CONCLUSIONS
Time pressure, more common in women and general internists, was related to chaos, control and culture, and stress, burnout, and intent to leave. Future studies should evaluate these findings in larger and more geographically diverse samples.

Identifiants

DOI: 10.1007/s11606-019-05343-6 PMID: 31797160 PMC: PMC7018911
pubmed: 31797160
doi: 10.1007/s11606-019-05343-6
pii: 10.1007/s11606-019-05343-6
pmc: PMC7018911
doi:

Types de publication

Journal Article Randomized Controlled Trial Research Support, U.S. Gov't, P.H.S.

Langues

eng

Sous-ensembles de citation

IM

Pagination

465-472

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Auteurs

Kriti Prasad (K)

Division of General Internal Medicine, Hennepin Healthcare, Minneapolis, MN, USA.
Office of Professional Worklife, Hennepin Healthcare, Minneapolis, MN, USA.
Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, MN, USA.

Sara Poplau (S)

Division of General Internal Medicine, Hennepin Healthcare, Minneapolis, MN, USA.
Office of Professional Worklife, Hennepin Healthcare, Minneapolis, MN, USA.
Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, MN, USA.

Roger Brown (R)

School of Nursing, UW-Madison, Madison, WI, USA.

Steven Yale (S)

University of Central Florida College of Medicine, Lake Nona, Orlando, FL, USA.

Ellie Grossman (E)

Cambridge Health Alliance, Cambridge, MA, USA.

Anita B Varkey (AB)

Loyola University Stritch School of Medicine, Maywood, IL, USA.

Eric Williams (E)

University of Alabama, Tuscaloosa, AL, USA.

Hannah Neprash (H)

University of Minnesota School of Public Health, Minneapolis, MN, USA.

Mark Linzer (M)

Division of General Internal Medicine, Hennepin Healthcare, Minneapolis, MN, USA. Mark.linzer@hcmed.org.
Office of Professional Worklife, Hennepin Healthcare, Minneapolis, MN, USA. Mark.linzer@hcmed.org.
Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, MN, USA. Mark.linzer@hcmed.org.
Department of Medicine, Hennepin Healthcare, 701 Park Ave (G5), Minneapolis, MN, 55415, USA. Mark.linzer@hcmed.org.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Time Pressure During Primary Care Office...
questionsmedicales.fr › Phénomènes psychologiques › Psychologie appliquée › Satisfaction professionnelle › Time Pressure During Primary Care Office...
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Pratique professionnelle › Consultation médicale › Time Pressure During Primary Care Office...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Time Pressure During Primary Care Office...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Time Pressure During Primary Care Office...
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Gestion du personnel › Lieu de travail › Time Pressure During Primary Care Office...