Provision of Primary Care Under Reduced Visit Time Pressures

Importance: Primary care physicians face increasing pressure to deliver complex care within fixed, short visit durations. Prior evidence links higher time pressure to lower-quality care, but the effects of reduced time pressure on care delivery are not well understood. Objective: To evaluate whether reduced visit-level time pressure is associated with measures related to greater comprehensiveness and preventive care delivery in primary care visits, overall and by patient chronic condition burden and continuity with one's usual physician. Design, Setting, and Participants: This quasi-experimental cross-sectional study used electronic health record data from 2021 to 2024. The study included visits to primary care physicians at primary care practices within a large integrated health system in the Northeastern US who routinely offered same-day visit slots for adult patients in their schedules. Visits preceding an unfilled same-day visit (reduced time pressure) were compared with visits preceding a filled same-day visit (regular time pressure) using linear regression models that included physician and temporal fixed effects. Exposure: Reduced time pressure, defined as an unfilled same-day visit slot immediately following the index visit. Main Outcomes and Measures: Indicators for comprehensiveness of care (total and new diagnoses addressed, total and new prescriptions, diagnostic testing, and referrals) and ordering of preventive care (immunizations and health maintenance items). Results: Among 191 269 visits across 311 physicians (170 526 regular time pressure; 20 743, reduced time pressure), mean (SD) patient age was 57.7 (18.1) years, and 59.7% of visits were with female patients. Under reduced time pressure, physicians recorded 0.11 (95% CI, 0.08-0.15) more total diagnoses, 0.09 (95% CI, 0.07-0.11) more new diagnoses, and 0.02 (95% CI, 0.01-0.03) more new prescriptions, and ordered 0.08 (95% CI, 0.03-0.13) more diagnostic tests, with no differences in referrals or preventive care. The estimated effects of reduced time pressure on total and new diagnoses were largest among patients with 3 or more chronic conditions (total diagnoses: 0.16 [95% CI, 0.10-0.21]; new diagnoses: 0.10 [95% CI, 0.07-0.14]). Visits with a patient's usual physician included more orders for diagnostic testing and preventive care, although time pressure effects were similar when seeing one's usual physician vs another physician. Conclusions and Relevance: In this study, reduced time pressure visits had care patterns aligned with more comprehensive care, particularly for patients with multimorbidity. These modest results highlight the potential trade-offs between visit length and the scope of care delivered, underscoring the importance of addressing time constraints in primary care.