Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief (Plain Language Summaries)
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief (Plain Language Summaries)
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Research ArticleOriginal Research

The Changing Face of Chronic Illness Management in Primary Care: A Qualitative Study of Underlying Influences and Unintended Outcomes

Linda M. Hunt, Meta Kreiner and Howard Brody
The Annals of Family Medicine September 2012, 10 (5) 452-460; DOI: https://doi.org/10.1370/afm.1380
Linda M. Hunt
1Department of Anthropology, Michigan State University, East Lansing, Michigan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: huntli@msu.edu
Meta Kreiner
1Department of Anthropology, Michigan State University, East Lansing, Michigan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Howard Brody
2Institute for the Medical Humanities & Department of Family Medicine, University of Texas Medical Branch, Galveston, Texas
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Additional Files
  • Figure 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 1

    Schematic representation of potential benefit and harm when the diagnostic threshold for type 2 diabetes is moved lower, increasing the number of people taking medications.

Tables

  • Figures
  • Additional Files
    • View popup
    Table 1

    Criteria for Diagnosing Diabetes and Hypertension: Temporal Trends in Cutoffs for Starting Treatment9,11

    Condition and Cutoff1992199319982003Increase in Diagnosed Cases
    Diabetes: fasting plasma glucose, mg/dL
     Diabetes140–126–10.3 milliona
     PrediabetesNone–110100–
    Hypertension: blood pressure, mm Hg
     In nondiabetic patients160/95140/90––22.0 millionb
     In diabetic patients–––130/80–
    PrehypertensionNone––120/80–
    • ↵a Difference in the number of diagnosed cases of diabetes reported by the Centers for Disease Control and Prevention for 1997 and for 2009.39

    • ↵b Difference in number of diagnosed cases of hypertension reported by the Centers for Disease Control and Prevention for 1991 and 2008.40,41 Because these numbers were reported as a percentage of the population aged older than 20 years (25% in 1991 and 30% in 2008), we used the US census reports of adult population size12 to convert to millions of people for this table.

    • View popup
    Table 2

    Selected Characteristics of 58 Clinicians Interviewed, 2009–2010

    CharacteristicNo. (%)
    Sex
     Male26 (45)
     Female32 (55)
    Race/ethnicity
     Non-Hispanic white37 (63)
     African American10 (17)
     Native American2 (3)
     Pacific Islander2 (3)
     Asian5 (9)
     Hispanic2 (3)
    Age-group, ya
     24–3412 (21)
     35–4419 (33)
     45–5516 (27)
     >5511 (19)
    Degree
     Doctor of medicine34 (59)
     Doctor of osteopathy17 (29)
     Physician assistant2 (3)
     Nurse practitioner5 (9)
    Type of clinic
     University3 (5)
     Hospital/health system21 (36)
     Physician owned21 (36)
     FQHC8 (14)
     Other5 (9)
    Location of clinic
     Urban40 (69)
     Rural7 (12)
     Suburban11 (19)
    • FQHC=Federally Qualified Health Center.

    • ↵a Age range: 27 to 77 years; median: 43 years.

    • View popup
    Table 3

    Selected Characteristics of 70 Patients Interviewed, 2009–2010

    CharacteristicNo. (%)
    Sex
     Male33 (47)
     Female37 (53)
    Race/ethnicity
     Non-Hispanic white27 (38)
     African American21 (30)
     Native American3 (4)
     Hispanic19 (27)
    Age-group, ya
     24–342 (3)
     35–449 (13)
     45–5417 (24)
     55–6520 (29)
     >6522 (31)
    Diagnosis
     Diabetes only15 (21)
     Hypertension only14 (20)
     Both diabetes and hypertension41 (59)
    Interview language
     English53 (76)
     Spanish17 (24)
    Income ranges reported
     <$10,00021 (30)
     $11,000–$20,00016 (23)
     $21,000–$50,00015 (21)
     $51,000–$70,0004 (6)
     $71,000–$90,0004 (6)
     >$90,0004 (6)
     No answer6 (9)
    • ↵a Age range: 32 to 85 years; median: 58 years.

Additional Files

  • Figures
  • Tables
  • The Article in Brief

    Linda M. Hunt , and colleagues

    Background This study of management of type 2 diabetes and hypertension examines clinicians' treatment strategies, factors influencing treatment decisions, and patient understandings and experiences in managing these illnesses.

    What This Study Found With 11 percent of the US population and 40 percent of people older than 60 years taking 5 or more medications, this study examines the underlying influence and unintended outcomes of the dramatic rise in polypharmacy in patients with diabetes, hypertension, or both. The authors suggest that heavy use of pharmaceuticals is caused by a number of factors, most notably (1) increasingly stringent diagnostic and treatment thresholds for common chronic conditions, (2) clinician auditing and reward systems, and (3) a prescribing cascade whereby more medications are prescribed to control the effects of already prescribed medications. The authors identify several challenges to patient well-being resulting from a heavy reliance on pharmaceuticals, including financial costs and adverse drug effects. They present a conceptual model, the inverse benefit law, to provide insight into the impact of pharmaceutical marketing efforts on the observed trends.

    Implications

    • The authors call for (1) policies that will exclude individuals or organizations with financial conflicts of interest from involvement with guideline-writing panels, (2) physicians to be discouraged from seeing drug representatives, and (3) the monitoring of pay-for-performance plans for evidence of unintended negative effects on patients.
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 10 (5)
The Annals of Family Medicine
Vol. 10, Issue 5
September/October 2012
  • Table of Contents
  • Index by author
  • In Brief
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
The Changing Face of Chronic Illness Management in Primary Care: A Qualitative Study of Underlying Influences and Unintended Outcomes
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
6 + 5 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
The Changing Face of Chronic Illness Management in Primary Care: A Qualitative Study of Underlying Influences and Unintended Outcomes
Linda M. Hunt, Meta Kreiner, Howard Brody
The Annals of Family Medicine Sep 2012, 10 (5) 452-460; DOI: 10.1370/afm.1380

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
The Changing Face of Chronic Illness Management in Primary Care: A Qualitative Study of Underlying Influences and Unintended Outcomes
Linda M. Hunt, Meta Kreiner, Howard Brody
The Annals of Family Medicine Sep 2012, 10 (5) 452-460; DOI: 10.1370/afm.1380
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • FACTORS AFFECTING DIAGNOSIS AND TREATMENT
    • METHODS
    • RESULTS
    • DISCUSSION
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • How often do both core competencies of shared decision making occur in family medicine teaching clinics?
  • Trends and interaction of polypharmacy and potentially inappropriate prescribing in primary care over 15 years in Ireland: a repeated cross-sectional study
  • Challenges faced by primary care physicians when prescribing for patients with chronic diseases in a teaching hospital in Malaysia: a qualitative study
  • MAXimising Involvement in MUltiMorbidity (MAXIMUM) in primary care: protocol for an observation and interview study of patients, GPs and other care providers to identify ways of reducing patient safety failures
  • In This Issue: Local+Familiar=Healthier
  • Google Scholar

More in this TOC Section

  • Primary Care Physicians’ and Patients’ Perspectives on Equity and Health Security of Infectious Disease Digital Surveillance
  • The Impact of Community Health Information Exchange Usage on Time to Reutilization of Hospital Services
  • Impact of Primary Care Attributes on Hospitalization During the COVID-19 Pandemic: A Nationwide Prospective Cohort Study in Japan
Show more Original Research

Similar Articles

Subjects

  • Domains of illness & health:
    • Chronic illness
  • Methods:
    • Qualitative methods
  • Other research types:
    • Professional practice
  • Other topics:
    • Patient perspectives
    • Communication / decision making
    • Multimorbidity

Content

  • Current Issue
  • Past Issues
  • Past Issues in Brief
  • Multimedia
  • Articles by Type
  • Articles by Subject
  • Multimedia
  • Supplements
  • Online First
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Media
  • Job Seekers

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2023 Annals of Family Medicine