More Indirect Patient Care Activities per Visit: 11-Year Analysis of Family Physician Electronic Health Records in Canada

PURPOSE Understanding and addressing increased administrative workload among family physicians is receiving attention, but data describing administrative tasks are limited. We used electronic health record (EHR) data to describe trends in orders made by family physicians, capturing changes in total workload per physician and the volume of per-patient contact over time. METHODS We used national Canadian Primary Care Sentinel Surveillance Network EHR data to measure annual counts of patient contacts, laboratory tests, referrals made, and prescriptions per physician from 2011 to 2021. We evaluated trends in the annual rates of these orders per patient contact by fitting multivariable Poisson regression within a generalized estimating equation framework. RESULTS Family physicians reporting EHR data saw more unique patients, had more total contacts, and had more days with patient contact in 2021 than 2011. In 2021, the average numbers of laboratory tests, referrals, and prescriptions per physician were greater than in 2011 (68.5%, 80.2%, and 43.1% increases, respectively). Rates of referrals and laboratory tests increased by 57% (incident rate ratio IRR2021; 95% CI = 1.57; 1.36-1.80) and 29% (IRR2021; 95% CI = 1.29; 1.18-1.41), respectively. The number of prescriptions per patient contact remained constant (IRR2021; 95% CI = 0.96; 0.90-1.03). CONCLUSIONS Our results suggest a significant increase in family physician administrative workload per patient contact over a period of 11 years. Whereas further research is needed to better understand drivers of increased referrals and laboratory tests, strategies to streamline administrative tasks in primary care could help inform the development of effective policy.