Dataset Information

Much to do with nothing: microsimulation study on time management in primary care.

ABSTRACT:

Objective

To investigate the credibility of claims that general practitioners lack time for shared decision making and preventive care.

Design

Monte Carlo microsimulation study.

Setting

Primary care, United States.

Participants

Sample of general practitioners (n=1000) representative of annual work hours and patient panel size (n=2000 patients) in the US, derived from the National Health and Nutrition Examination Survey.

Main outcome measures

The primary outcome was the time needed to deliver shared decision making for highly recommended preventive interventions in relation to time available for preventive care-the prevention-time-space-deficit (ie, time-space needed by doctor exceeding the time-space available).

Results

On average, general practitioners have 29 minutes each workday to discuss preventive care services (just over two minutes for each clinic visit) with patients, but they need about 6.1 hours to complete shared decision making for preventive care. 100% of the study sample experienced a prevention-time-space-deficit (mean deficit 5.6 h/day) even given conservative (ie, absurdly wishful) time estimates for shared decision making. However, this time deficit could be easily overcome by reducing personal time and shifting gains to work tasks. For example, general practitioners could reduce the frequency of bathroom breaks to every other day and skip time with older children who don't like them much anyway.

Conclusions

This study confirms a widely held suspicion that general practitioners waste valuable time on "personal care" activities. Primary care overlords, once informed about the extent of this vast reservoir of personal time, can start testing methods to "persuade" general practitioners to reallocate more personal time toward bulging clinical demands.

SUBMITTER: Caverly TJ

PROVIDER: S-EPMC6292456 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Publications

Much to do with nothing: microsimulation study on time management in primary care.

Caverly Tanner J TJ Hayward Rodney A RA Burke James F JF

BMJ (Clinical research ed.) 20181213

<h4>Objective</h4>To investigate the credibility of claims that general practitioners lack time for shared decision making and preventive care.<h4>Design</h4>Monte Carlo microsimulation study.<h4>Setting</h4>Primary care, United States.<h4>Participants</h4>Sample of general practitioners (n=1000) representative of annual work hours and patient panel size (n=2000 patients) in the US, derived from the National Health and Nutrition Examination Survey.<h4>Main outcome measures</h4>The primary outcom ...[more]

PMID: 30545899

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Project description:IntroductionType-2 diabetes mellitus (T2DM) is a progressive disease, and many patients eventually require insulin therapy. This study examined real-world outcomes of switching basal insulin analogs among patients with T2DM.MethodsUsing two large United States administrative claims databases (IMPACT(®) and Humana(®)), this longitudinal retrospective study examined two cohorts of adult patients with T2DM. Previously on insulin glargine, Cohort 1 either continued insulin glargine (GLA-C) or switched to insulin detemir (DET-S), while Cohort 2 was previously on insulin detemir, and either continued insulin detemir (DET-C) or switched to insulin glargine (GLA-S). One-year follow-up treatment persistence and adherence, glycated hemoglobin (HbA1c), hypoglycemia events, healthcare utilization and costs were assessed. Selection bias was minimized by propensity score matching between treatment groups within each cohort.ResultsA total of 5,921 patients (mean age 60 years, female 50.0%, HbA1c 8.6%) were included in the analysis (Cohort 1: IMPACT(®): n = 536 DET-S matched to n = 2,668 GLA-C; Humana(®): n = 256 DET-S matched to n = 1,262 GLA-C; Cohort 2: n = 419 GLA-S matched to n = 780 DET-C), with similar baseline characteristics between treatment groups in each cohort. During 1-year follow-up, in Cohort 1, DET-S patients, when compared with GLA-C patients, had lower treatment persistence/adherence with 33-40% restarting insulin glargine, higher rapid-acting insulin use, worse HbA1c outcomes, significantly higher diabetes drug costs, and similar hypoglycemia rates, health care utilization and total costs. However, in Cohort 2 overall opposite outcomes were observed and only 19.8% GLA-S patients restarted insulin detemir.ConclusionsThis study showed contrasting clinical and economic outcomes when patients with T2DM switched basal insulin analogs, with worse outcomes observed for patients switching from insulin glargine to insulin detemir and improved outcomes when switching from insulin detemir to insulin glargine. Further investigation into the therapeutic interchangeability of insulin glargine and insulin detemir in the real-world setting is needed.

Dataset Information

Much to do with nothing: microsimulation study on time management in primary care.

Objective

Design

Setting

Participants

Main outcome measures

Results

Conclusions

Publications

Much to do with nothing: microsimulation study on time management in primary care.

Similar Datasets

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