A Narrative Review of Slow Medicine Outcomes.

Abstract

Primary care practice in the United States suffers from short consultation duration and distracting electronic health record tasks. This leads to patient and physician dissatisfaction and physician burnout, as well as potentially unnecessary referrals and interventions. Slow medicine - providing longer and higher-quality consultations - has been proposed to improve medical care quality and patient outcomes. However, definitive outcome data for US settings are lacking. Following a structured narrative approach, we identified, reviewed, and synthesized existing reports (peer-reviewed and grey) to determine if there is sufficient evidence to support systematic evaluation of slow medicine in the US. We assessed whether longer versus shorter face-to-face primary care consultations were associated with quantitative patient outcomes including utilization; prevention; visit elements; medication adherence and prescription volume; mortality; and costs. We found suggestive evidence of substantial savings in hospital use and costs in varied geographic and clinical settings. However, this evidence lacks investigative rigor such as convincing prospective or natural randomization. With potentially significant health and financial benefits from slow medicine and little risk to subjects, randomized trials, natural experiments, and mixed methods evaluations are strongly indicated. We discuss the need for modified payment practices to facilitate a slow medicine approach.