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

Abstract

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...

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