The difference in outpatient psychiatric office visit duration for white
people and African Americans—a proxy for quality of care—appears
to have narrowed dramatically in recent years.
The average duration of outpatient visits by African Americans between 2001
and 2006—adjusted to account for potentially confounding patient,
psychiatrist, and practice characteristics—was 3.5 minutes shorter than
visits by white people, according to a report in the February Archives of
But that disparity is largely due to the substantial gap of 7.4 minutes
that existed in the early years of the period, 2001 to 2004. Between 2004 and
2006 the gap virtually disappeared, dropping to 0.1 minute.
The analysis controlled for difference in duration of visits for
psychotherapy and medication management, so that the racial difference in
visit duration during the five-year period—as well as its significant
narrowing in the last three years of the study period—was not mediated
by psychotherapy, use of medication, or changes in these variables on the part
of either racial group.
"Office visit duration can be thought of as a proxy for clinical
attention and therefore serves as a measure of quality of care," said
study author Marc Olfson, M.D., a professor of clinical psychiatry at Columbia
University College of Physicians and Surgeons and the New York State
Psychiatric Institute. "It's heartening, because it seems the
differences between the races [with regard to this variable] have all but
disappeared in recent years. And that change is not attributable to changes in
rates of psychotherapy or medication management."
Nor can the closing of the gap in visit duration be explained by an overall
decrease in visit length from the 2001-2003 period to the 2003-2006 period. In
the first three years, the average adjusted length of an office visit for
white people was 32.9 minutes; in the latter half of the study period, that
figure dropped only slightly to 32.5 minutes.
But the average length of visits for African Americans rose from 25.5
minutes in the first three years to 32.4 minutes in the later half of the
"We are left with a puzzle," said Olfson. "I can only
speculate that perhaps there really have been recent changes in public
attitudes with people, including psychiatrists, becoming more comfortable
talking across racial groups about mental health problems."
He noted that the study analyzes a period when racial disparities in access
to and quality of care became a subject of national focus. "It's also
true that there has been a lot of attention devoted to this general topic and
a greater public awareness of threats to the quality of health care posed by
racial disparities," he said. "The narrowing of the racial gap in
visit duration in recent years is a welcome development, but it's not one that
we can confidently assign to any one particular cause."
Data for the study were drawn from the 2001-2006 National Ambulatory
Medical Care Survey, a probability sample survey of office-based physicians in
the United States conducted by the Centers for Disease Control and
Prevention's National Center for Health Statistics.
Physicians were instructed to fill out a patient record form for each
sampled visit. The number of forms completed each year by respondent
psychiatrists ranged from a low of 1,469 in 2003 to a high of 1,896 in 2004. A
total of 7,094 office visits were made by white patients, and 504 visits were
made by African-American patients.
The unadjusted mean duration of psychiatric outpatient visits by
African-American patients over the entire study period was 4.4 minutes shorter
than that of white patients and 3.5 minutes shorter after controlling for
potential confounding variables.
Interestingly, a significant race-related difference in visit duration was
evident among visits financed by Medicare but not other sources of payment.
Olfson noted that African Americans are much less likely to have private
supplemental insurance to cover charges above Medicare-approved amounts.
"It may be that additional reimbursement from supplemental insurance
contributes to longer visits," he told Psychiatric News."
It's one area where there are persisting differences."
An abstract of "Racial Differences in Visit Duration of
Outpatient Psychiatric Visits" is posted at<http://archpsyc.ama-assn.org/cgi/content/abstract/66/2/214>.▪