Managing consultation duration in primary care: A systematic review with health equity insights.

Abstract

<h4>Introduction</h4>In the past, reviews have found high levels of variability in physician consultation times across the globe in general patients attending primary care consultations. The matter remains a pressing public health policy topic, given that some health systems put pressure to decrease time physicians may spend with their patients. Little is presently known about the consultation time needs in specific potentially vulnerable populations including patients with disabilities, multimorbid conditions, older adults, patients from lower socioeconomic status, and patients in need of an interpreter. It is important to undertake a systematic review of the consultation time needs of these populations in order to better understand their needs and to reduce equity issues in accessibility to healthcare.<h4>Methods</h4>A systematic review of PubMed and Medline, Web of Science, and Google Scholar was undertaken for all relevant studies on consultation time in specific populations including patients with chronic and multimorbid conditions, mental or psychological disorders, disabilities, migrants, and older adults that have been published over the past 20 years from 2002-2022. Studies in patients who did not belong to these specific groups were excluded.<h4>Results</h4>A total of 65 articles met inclusion criteria and were included in this review. Patients from specific populations have unique consultation time needs. Patients with the greatest time needs from these specific populations in descending order include patients with mental health or psychological disorders as well as patients requiring interpreters, followed by patients with multimorbid conditions, and finally older adults. Patients need adequate time to schedule an interpreter and to allow for communication between the patient, doctor, and interpreter which fosters meaningful discussion. Patients with mental health disorders need much time to discuss their challenges (mean duration from 10.6 up to 60 min). Multimorbid patients have increasing consultation lengths in a dose-dependent manner with rising number of health problems. Older adults spent between 10.6 and 26.7 min with their general practitioners (GPs). Patients with disabilities are understudied but overall raise similar concerns around time constraints. Patients from lower socioeconomic status experience inequities stemming from shorter consultations irrespective of their chronic disease statuses.<h4>Discussion</h4>Inequities in health accessibility exist in specific populations if sufficient time is not accorded to meet their unique health needs. A fixed appointment time could create disadvantages for these populations. Future research is needed to better understand what the ideal consultation time would be for these populations or whether individually tailored approaches are needed.<h4>Conclusion</h4>Policymakers should consider flexible appointments for patients from specific populations to prevent accessibility issues to healthcare and subsequent perpetuated health inequities. Future research is also needed to better understand the ideal consultation duration for certain patients based on their unique needs, especially those with disabilities.