Time constraints limit the ability of physicians to comply with preventive services recommendations.

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. METHODSWe 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. INTRODUCTION Many Americans are not receiving recommended health care services. Despite the existence of established clinical guidelines, which are expected to facilitate more consistent and effective medical practice and improve health outcomes, Americans receive only about one half of the applicable services for acute, preventive, and chronic disease care.1 Chronic disease care is of particular concern, as chronic diseases have become more widespread and are often poorly controlled.For instance, hypertension affects approximately 50 million Americans and will become more common as the population ages; however, only 34% of the population with hypertension has blood pressures in the recommended range.2 Control of diabetes mellitus is also elusive: only 37% of patients with diabetes have glycated hemoglobin (HbA 1c ) values at or below the recommended level.3 The human costs are substantial: poor blood pressure control contributes to more than 68,000 preventable deaths annually, 4 and strict blood glucose control can decrease the risk of complications in patients with diabetes by 25%. 5,6 Barriers to chronic care delivery include a limited orientation to disease monitoring and lack of offi ce systems for chronic disease care.7 Time constraints in primary care have been shown to limit the delivery of preventive services 8 and likely also limit the delivery of care for chronic disease. It is diffi cult, if not impossible, to measure the exact amount of time 210CHRONIC DISEASE MANAGEMENT a physician should spend managing chronic diseases because of variability among patients in their disease processes, responses to medication, and lifestyle and social issues. It is, however, possible to estim...

Community engagement (CE) and community-engaged research (CEnR) are increasingly viewed as the keystone to translational medicine and improving the health of the nation. In this article, the authors seek to assist academic health centers (AHCs) in learning how to better engage with their communities and build a CEnR agenda by suggesting five steps: defining community and identify partners; learning the etiquette of community engagement; building a sustainable network of CEnR researchers; recognizing that CEnR will require the development of new methodologies; and improving translation and dissemination plans. Health disparities that lead to uneven access to and quality of care as well as high costs will persist without a CEnR agenda that finds answers to both medical and public health questions. One of the biggest barriers toward a national CEnR agenda, however, are the historical structures and processes of an AHC – including the complexities of how institutional review boards operate, accounting practices and indirect funding policies, and tenure and promotion paths. Changing institutional culture starts with the leadership and commitment of top decision-makers in an institution. By aligning the motivations and goals of their researchers, clinicians, and community members into a vision of a healthier population, AHC leadership will not just improve their own institutions, but improve the health of the nation – starting with improving the health of their local communities, one community at a time.

Coronavirus disease 2019 (COVID-19) has underscored longstanding societal differences in the drivers of health and demonstrated the value of applying a health equity lens to engage at-risk communities, communicate with them effectively, share data, and partner with them for program implementation, dissemination, and evaluation. Examples of engagement — across diverse communities and with community organizations; tribes; state and local health departments; hospitals; and universities — highlight the opportunity to apply lessons from COVID-19 for sustained changes in how public health and its partners work collectively to prevent disease and promote health, especially with our most vulnerable communities.

BackgroundDelivery of preventive health services in primary care is lacking. One of the main barriers is lack of time. We estimated the amount of time primary care physicians spend on important preventive health services.MethodsWe analyzed a large dataset of primary care (family and internal medicine) visits using the National Ambulatory Medical Care Survey (2001–4); analyses were conducted 2007–8. Multiple linear regression was used to estimate the amount of time spent delivering each preventive service, controlling for demographic covariates.ResultsPreventive visits were longer than chronic care visits (M = 22.4, SD = 11.8, M = 18.9, SD = 9.2, respectively). New patients required more time from physicians. Services on which physicians spent relatively more time were prostate specific antigen (PSA), cholesterol, Papanicolaou (Pap) smear, mammography, exercise counseling, and blood pressure. Physicians spent less time than recommended on two "A" rated ("good evidence") services, tobacco cessation and Pap smear (in preventive visits), and one "B" rated ("at least fair evidence") service, nutrition counseling. Physicians spent substantial time on two services that have an "I" rating ("inconclusive evidence of effectiveness"), PSA and exercise counseling.ConclusionEven with limited time, physicians address many of the "A" rated services adequately. However, they may be spending less time than recommended for important services, especially smoking cessation, Pap smear, and nutrition counseling. Future research is needed to understand how physicians decide how to allocate their time to address preventive health.