Article Figures & Data
Tables
- Table 1.
Estimated Patient Populations in the Model Practice, Based on US Census Data (2002)
Age-groups US Population Patients From: United States Census Bureau.15 <18 y 72,894,483 632 18–24 y 28,341,732 246 25–29 y 18,971,891 164 30–34 y 20,956,412 182 35–39 y 21,914,882 190 40–44 y 23,001,724 199 45–49 y 21,302,064 185 50–54 y 18,781,873 163 55–59 y 14,990,542 130 60–64 y 11,611,184 101 65–69 y 9,580,927 83 70–74 y 8,693,288 75 75 y + 17,327,696 150 Total 288,368,698 2,500 - Table 2.
Summary of Primary Care Time Requirements for 10 Chronic Diseases, Assuming the Disease is Stable and in Good Control
Disease Number of Cases Visits Per Year Minutes Per Visit Minutes Per Disease Per Year Hours 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. Hyperlipidemia 511 2 10 20 170 Hypertension 472 2 10 20 157 Depression 118 4 10 40 92 Asthma 183 2 10 20 61 Diabetes 145 2 10 20 48 Arthritis 381 2 10 20 127 Anxiety 279 2 10 20 107 Osteoporosis 140 1 10 10 23 COPD 131 1 10 10 22 CAD 120 1 10 10 20 Total hours per year 828 Total hours per work day 3.5 No. (%) of Cases Number of Visits Disease Total Cases Uncontrolled Controlled Uncontrolled Controlled Minutes per Visit Hours Per Year Hyperlipidemia 511 417 (81.6) 94 (18.4) 8 2 10 587 Hypertension 472 312 (66) 160 (34) 12 2 10 704 Depression 118 58 (49) 60 (51) 12 4 10 156 Asthma 183 62 (33.6) 121 (66.3) 4 2 10 82 Diabetes 145 91 (63) 54 (37) 4 2 10 79 Total hours per year 1,581 Total hours per work day 6.7 - Table 4.
Factors Not Accounted for in Estimates of Time Required for Chronic Disease Management in Primary Care
-
Other chronic diseases not included in Table 2
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Initial visits for assessment and diagnosis
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Initiation of new drug regimen (eg, insulin)
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Patient ability to comply with instructions
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Treatment of complications and sequelae
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Additional Files
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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