Is There Time for Management of Patients With Chronic Diseases in Primary Care?

By Truls Østbye, K. Yarnall, Katrina M. Krause, K. Pollak, M. Gradison, J. Lloyd Michener. Annals of Family Medicine, 2005

734 citations recorded by the source corpus.

PURPOSE Despite the availability of national practice guidelines, many patients fail to receive recommended chronic disease care. Physician time constraints in primary care are likely one cause. METHODS We applied guideline recommendations for 10 common chronic diseases to a panel of 2,500 primary care patients with an age-sex distribution and chronic disease prevalences similar to those of the general population, and estimated the minimum physician time required to deliver high-quality care for these conditions. The result was compared with time available for patient care for the average primary care physician. RESULTS Eight hundred twenty-eight hours per year, or 3.5 hours a day, were required to provide care for the top 10 chronic diseases, provided the disease is stable and in good control. We recalculated this estimate based on increased time requirements for uncontrolled disease. Estimated time required increased by a factor of 3. Applying this factor to all 10 diseases, time demands increased to 2,484 hours, or 10.6 hours a day. CONCLUSIONS Current practice guidelines for only 10 chronic illnesses require more time than primary care physicians have available for patient care overall. Streamlined guidelines and alternative methods of service delivery are needed to meet recommended standards for quality health care.

Subfields: Endocrinology, Diabetes and Metabolism, Epidemiology, General Health Professions

View Paper: https://www.semanticscholar.org/paper/bf8043add3201ea1097494f1121da44c48f9448a

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Endocrinology, Diabetes and Metabolism

1. John D. Piette
2. E. Kerr

In Epidemiology

1. John D. Piette
2. Thomas Bodenheimer
3. E. Kerr

In General Health Professions

1. John D. Piette
2. Thomas Bodenheimer
3. E. Kerr

Citations in the corpus

• The impact of comorbid chronic conditions on diabetes care. (2006, background): “Given intensive time constraints, clinicians often must make decisions about where to focus treatment priorities during outpatient encounters (11,49,50).”
• Future of Multimorbidity Research: How Should Understanding of Multimorbidity Inform Health System Design? (2010, background): “Second, the generation of evidence, the synthesis of evidence in guidelines, the development of quality standards, and the setting of healthcare system policy need to account for these issues, and prioritize across conditions and approaches to healthcare for those elements that are most important fo”
• Confronting the growing burden of chronic disease: can the U.S. health care workforce do the job? (2009, background): “6 hours per working day to provide highquality chronic care to a typical patient panel (the total number of patients—averaging about 2,300 in the United States—for whom a PCP is responsible).(16) The multidisciplinary team scenario.”