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Research ArticleOriginal Research

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

Truls Østbye, Kimberly S. H. Yarnall, Katrina M. Krause, Kathryn I. Pollak, Margaret Gradison and J. Lloyd Michener
The Annals of Family Medicine May 2005, 3 (3) 209-214; DOI: https://doi.org/10.1370/afm.310
Truls Østbye
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Kimberly S. H. Yarnall
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Katrina M. Krause
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Kathryn I. Pollak
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Margaret Gradison
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J. Lloyd Michener
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Article Figures & Data

Tables

  • Additional Files
    • View popup
    Table 1.

    Estimated Patient Populations in the Model Practice, Based on US Census Data (2002)

    Age-groupsUS PopulationPatients
    From: United States Census Bureau.15
    <18 y72,894,483632
    18–24 y28,341,732246
    25–29 y18,971,891164
    30–34 y20,956,412182
    35–39 y21,914,882190
    40–44 y23,001,724199
    45–49 y21,302,064185
    50–54 y18,781,873163
    55–59 y14,990,542130
    60–64 y11,611,184101
    65–69 y9,580,92783
    70–74 y8,693,28875
    75 y +17,327,696150
    Total288,368,6982,500
    • View popup
    Table 2.

    Summary of Primary Care Time Requirements for 10 Chronic Diseases, Assuming the Disease is Stable and in Good Control

    DiseaseNumber of CasesVisits Per YearMinutes Per VisitMinutes Per Disease Per YearHours Per Year
    Note: Patients with more than 1 of the 10 diseases appear more than once. Summary of time assuming that the disease is “stable,” “in control,” “at goal,” or “in maintenance phase.”
    COPD = chronic obstructive pulmonary disease; CAD = coronary artery disease.
    Hyperlipidemia51121020170
    Hypertension47221020157
    Depression1184104092
    Asthma1832102061
    Diabetes1452102048
    Arthritis38121020127
    Anxiety27921020107
    Osteoporosis1401101023
    COPD1311101022
    CAD1201101020
    Total hours per year828
    Total hours per work day3.5
    • View popup
    Table 3.

    Effect of Disease Control Status on Time Requirements for 5 Chronic Diseases

    No. (%) of CasesNumber of Visits
    DiseaseTotal CasesUncontrolledControlledUncontrolledControlledMinutes per VisitHours Per Year
    Hyperlipidemia511417 (81.6)94 (18.4)8210587
    Hypertension472312 (66)160 (34)12210704
    Depression11858 (49)60 (51)12410156
    Asthma18362 (33.6)121 (66.3)421082
    Diabetes14591 (63)54 (37)421079
    Total hours per year1,581
    Total hours per work day6.7
    • View popup
    Table 4.

    Factors Not Accounted for in Estimates of Time Required for Chronic Disease Management in Primary Care

    1. Other chronic diseases not included in Table 2

    2. Initial visits for assessment and diagnosis

    3. Initiation of new drug regimen (eg, insulin)

    4. Patient ability to comply with instructions

    5. Treatment of complications and sequelae

Additional Files

  • Tables
  • Supplemental Appendix

    Supplemental Appendix. Total Time Required to Provide Recommended Chronic Disease Care for Standard Panel of Patients for 1 Year (Concise Notation)

    Files in this Data Supplement:

    • Supplemental data: Appendix - PDF file, 1 page, 52 KB
  • The Article in Brief

    Background: Many Americans are not receiving recommended health care services. This is of particular concern for patients with chronic illnesses, such as high blood pressure or diabetes, because chronic illnesses can be difficult to control. This study estimated the amount of time required to care for patients with chronic illnesses if national guidelines are followed.
    What This Study Found: An average primary care doctor needs at least 2,484 hours per year, or 10.6 hours per day, to provide care for 10 common chronic diseases. This is more time than primary care doctors have available for all patient care. Furthermore, it does not include the time needed to provide preventive care, acute care, and needed follow-up.
    Implications:
    * The time requirements for health care guidelines are an obstacle to delivering care to patients with chronic diseases.
    * Guideline developers should carefully consider the time required to follow recommendations.
    * It might be helpful to write guidelines that include more than one condition, rather than multiple single guidelines.

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    The Annals of Family Medicine: 3 (3)
    The Annals of Family Medicine
    Vol. 3, Issue 3
    1 May 2005
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    Is There Time for Management of Patients With Chronic Diseases in Primary Care?
    Truls Østbye, Kimberly S. H. Yarnall, Katrina M. Krause, Kathryn I. Pollak, Margaret Gradison, J. Lloyd Michener
    The Annals of Family Medicine May 2005, 3 (3) 209-214; DOI: 10.1370/afm.310

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    Is There Time for Management of Patients With Chronic Diseases in Primary Care?
    Truls Østbye, Kimberly S. H. Yarnall, Katrina M. Krause, Kathryn I. Pollak, Margaret Gradison, J. Lloyd Michener
    The Annals of Family Medicine May 2005, 3 (3) 209-214; DOI: 10.1370/afm.310
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