Association between consultation length and patient experience of ambulatory care in China: a cross-sectional study

Abstract

BackgroundA longer time in consultation with doctors in ambulatory care has been associated with better quality of care. Patient experience is of great concern to policy makers and is linked with health-care quality. However, the relationship between consultation length and patient experience remains unclear. We aimed to investigate the effect of consultation length on patient experience, based on analysis of a cross-sectional nationwide patient survey data in China. MethodsWe obtained patient survey data from a stratified nationwide survey sample that covered 136 tertiary hospitals in China. Patient-estimated consultation length and associated patient experience data were collected by questionnaire after each patient attended a face-to-face consultation with a doctor. The consultation experience was rated on a 5-point scale. We applied a two-piecewise linear regression model to examine the saturation effect of the consultation length on patient experience (consultation score), using a smoothing function, while age, sex, education, and profession were adjusted in the model, then estimated the turning point that gave the maximum model likelihood by using trial and error. FindingsBetween Dec 18, 2017, and Dec 30, 2017, 27 721 patients, aged 15–85 years, were eligible and selected for inclusion. The median patient-reported duration of face-to-face ambulatory care consultation was 10 min (IQR 5–12), and the mean score of the consultation experience rated by the patient was 4·25 (SD 0·83; 95% CI 4·24–4·26) on the 5-point scale. After adjusting for potential confounders including age, sex, education, and profession, there was a non-linear relationship between consultation length and measure of patient experience after smooth curve fitting. A turning point at 8 min was identified in the modelling process. Below this point, there was a higher probability of rating a consultation score above average with longer consultation length (odds ratio [OR] 1·28, 95% CI 1·26–1·30, p<0·001). After this point, the OR changed to 1·03 (95% CI 1·02–1·04, p<0·001). There was a significant difference in patient experience measure before and after this consultation length turning point (p<0·001). InterpretationConsultation length was associated with a measure of patient experience in a non-linear pattern. Longer consultations might not be required to achieve better patient experience, but an adequate consultation should not be shorter than 8 min. Future research about the appropriateness of consultation length for varies ambulatory care institutions would be of benefit. FundingNational Natural Science Foundation of China (71532014), National Health Commission of China