"Comparing the early period (1997 to 2001) with the late period (2002 to 2005), quality of care improved for one of three counseling or screening indicators and for four of six medication indicators," the authors write. Visits for counseling or screening generally took 2.6 to 4.2 minutes longer than visits in which patients did not receive these services, while providing appropriate medication therapy was not associated with longer visit duration.

"Although it is possible that physicians have become less efficient over time, it is far more likely that visit duration has increased because it takes more resources or time to care for an older and sicker population," the authors conclude. "Improvements in quality of care will likely require a combination of investments in systems such as electronic health records, greater use of other professionals such as nurse practitioners and better reimbursement to primary care physicians for the extra time spent."archinte.ama-assn/