Dataset Information

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

ABSTRACT:

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?ConclusionsTime 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.

SUBMITTER: Prasad K

PROVIDER: S-EPMC7018911 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Publications

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

Prasad Kriti K Poplau Sara S Brown Roger R Yale Steven S Grossman Ellie E Varkey Anita B AB Williams Eric E Neprash Hannah H Linzer Mark M

Journal of general internal medicine 20191203 2

<h4>Background</h4>The relationship between worklife factors, clinician outcomes, and time pressure during office visits is unclear.<h4>Objective</h4>To quantify associations between time pressure, workplace characteristics ,and clinician outcomes.<h4>Design</h4>Prospective analysis of data from the Healthy Work Place randomized trial.<h4>Participants</h4>168 physicians and advanced practice clinicians in 34 primary care practices in Upper Midwest and East Coast.<h4>Main measures and methods</h4 ...[more]

PMID: 31797160

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Project description:BackgroundDirect-to-consumer telemedicine is an increasingly used modality to access primary care. Previous research on assessment using synchronous virtual visits showed mixed results regarding antibiotic prescription rates, and research on assessment using asynchronous chat-based eVisits is lacking.ObjectiveThe goal of the research was to investigate if eVisit management of sore throat, other respiratory symptoms, or dysuria leads to higher rates of antibiotic prescription compared with usual management using physical office visits.MethodsData from 3847 eVisits and 759 office visits for sore throat, dysuria, or respiratory symptoms were acquired from a large private health care provider in Sweden. Data were analyzed to compare antibiotic prescription rates within 3 days, antibiotic type, and diagnoses made. For a subset of sore throat visits (n=160 eVisits, n=125 office visits), Centor criteria data were manually extracted and validated.ResultsAntibiotic prescription rates were lower following eVisits compared with office visits for sore throat (169/798, 21.2%, vs 124/312, 39.7%; P<.001) and respiratory symptoms (27/1724, 1.6%, vs 50/251, 19.9%; P<.001), while no significant differences were noted comparing eVisits to office visits for dysuria (1016/1325, 76.7%, vs 143/196, 73.0%; P=.25). Guideline-recommended antibiotics were prescribed similarly following sore throat eVisits and office visits (163/169, 96.4%, vs 117/124, 94.4%; P=.39). eVisits for respiratory symptoms and dysuria were more often prescribed guideline-recommended antibiotics (26/27, 96.3%, vs 37/50, 74.0%; P=.02 and 1009/1016, 99.3%, vs 135/143, 94.4%; P<.001, respectively). Odds ratios of antibiotic prescription following office visits compared with eVisits after adjusting for age and differences in set diagnoses were 2.94 (95% CI 1.99-4.33), 11.57 (95% CI 5.50-24.32), 1.01 (95% CI 0.66-1.53), for sore throat, respiratory symptoms, and dysuria, respectively.ConclusionsThe use of asynchronous eVisits for the management of sore throat, dysuria, and respiratory symptoms is not associated with an inherent overprescription of antibiotics compared with office visits.Trial registrationClinicalTrials.gov NCT03474887; https://clinicaltrials.gov/ct2/show/NCT03474887.

Project description:Most wearable devices that measure movement in workplaces cannot determine the context in which people spend time. This study examined the accuracy of Bluetooth sensing (10-second intervals) via the ActiGraph GT9X Link monitor to determine location in an office setting, using two simple, bespoke algorithms.For one work day (mean±SD 6.2±1.1 hours), 30 office workers (30% men, aged 38±11 years) simultaneously wore chest-mounted cameras (video recording) and Bluetooth-enabled monitors (initialised as receivers) on the wrist and thigh. Additional monitors (initialised as beacons) were placed in the entry, kitchen, photocopy room, corridors, and the wearer's office. Firstly, participant presence/absence at each location was predicted from the presence/absence of signals at that location (ignoring all other signals). Secondly, using the information gathered at multiple locations simultaneously, a simple heuristic model was used to predict at which location the participant was present. The Bluetooth-determined location for each algorithm was tested against the camera in terms of F-scores.When considering locations individually, the accuracy obtained was excellent in the office (F-score = 0.98 and 0.97 for thigh and wrist positions) but poor in other locations (F-score = 0.04 to 0.36), stemming primarily from a high false positive rate. The multi-location algorithm exhibited high accuracy for the office location (F-score = 0.97 for both wear positions). It also improved the F-scores obtained in the remaining locations, but not always to levels indicating good accuracy (e.g., F-score for photocopy room ?0.1 in both wear positions).The Bluetooth signalling function shows promise for determining where workers spend most of their time (i.e., their office). Placing beacons in multiple locations and using a rule-based decision model improved classification accuracy; however, for workplace locations visited infrequently or with considerable movement, accuracy was below desirable levels. Further development of algorithms is warranted.

Dataset Information

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

Background

Objective

Design

Participants

Main measures and methods

Key results

Publications

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

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