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
-
Initial visits for assessment and diagnosis
-
Initiation of new drug regimen (eg, insulin)
-
Patient ability to comply with instructions
-
Treatment of complications and sequelae
-
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.
Jump to section
Related Articles
Cited By...
- Toward a universal definition of provider-patient attachment in primary care
- Does Clinical Decision Support Increase Appropriate Medication Prescribing for Cardiovascular Risk Reduction?
- General practitioner residents experiences and perceptions of outpatient training in primary care settings in China: a qualitative study
- Reducing Acute Hospitalizations at High-Performing CPC+ Primary Care Practice Sites: Strategies, Activities, and Facilitators
- High cost of broken relationships
- Impact of primary care usual provider type and provider interdependence on outcomes for patients with diabetes: a cohort study
- Goal-Oriented Prevention: How to Fit a Square Peg into a Round Hole
- Goal-Oriented Prevention: How to Fit a Square Peg into a Round Hole
- High cost of broken relationships
- Neck pain service utilization and costs: association with timing of non-pharmaceutical services for individuals initially contacting a primary care provider. A retrospective cohort study
- Impact of quality improvement initiatives to improve CKD referral patterns: a systematic review protocol
- Impact of Team-Based Care on Emergency Department Use
- Enhancing primary care capacity in chronic kidney disease management: a quality improvement educational initiative
- Report: Evaluating the ability of the TMA Clinical Decision Support platform to identify interventions in a clinical setting
- Perceived facilitators and barriers to chronic disease management in primary care networks of Singapore: a qualitative study
- US Primary Care Physicians Viewpoints on HPV Vaccination for Adults 27 to 45 Years
- Do Medical Scribes Help Primary Care Providers Respond More Quickly to Out-of-Visit Tasks?
- Factors That Influence Changes to Existing Chronic Pain Management Plans
- Home Blood Pressure Monitoring in Cases of Clinical Uncertainty to Differentiate Appropriate Inaction From Therapeutic Inertia
- Task Sharing Chronic Disease Self-Management Training With Lay Health Coaches to Reduce Health Disparities
- Positive reinforcement by general practitioners is associated with greater physical activity in adults with type 2 diabetes
- Patient-Physician Agreement in Reporting and Prioritizing Existing Chronic Conditions
- Patient-Defined Visit Priorities in Primary Care: Psychosocial Versus Medically-Related Concerns
- Sources and Impact of Time Pressure on Opioid Management in the Safety-Net
- Visit Planning Using a Waiting Room Health IT Tool: The Aligning Patients and Providers Randomized Controlled Trial
- What are the most common conditions in primary care?: Systematic review
- Multimorbidity in Older Adults With Cardiovascular Disease
- Demandes concurrentielles et possibilites en soins primaires
- Competing demands and opportunities in primary care
- Longitudinal qualitative study describing family physicians experiences with attempting to integrate physical activity prescriptions in their practice: 'Its not easy to change habits
- The Integral Role of the Clinical Pharmacist Practitioner in Primary Care
- Delivery of Health Coaching by Medical Assistants in Primary Care
- Willingness of patients with diabetes to use an ICT-based self-management tool: a cross-sectional study
- Erreurs medicales, anciennes habitudes, mauvaise pratique
- Medical errors, old habits, bad practice
- Health Benefits and Cost-Effectiveness of Brief Clinician Tobacco Counseling for Youth and Adults
- Seeing the Person, Not the Illness: Promoting Diabetes Medication Adherence Through Patient-Centered Collaboration
- Les lignes directrices en soins primaires devraient-elles etre redigees par des medecins de famille?: OUI
- Should primary care guidelines be written by family physicians?: YES
- A Primary Care Panel Size of 2500 Is neither Accurate nor Reasonable
- Implementation of data management and effect on chronic disease coding in a primary care organisation: A parallel cohort observational study
- Effect of Physician Participation in a Multi-element Health Information and Data Exchange Program on Chronic Illness Medication Adherence
- Multimorbidity in primary care: protocol of a national cross-sectional study in Switzerland
- Simplified lipid guidelines: Prevention and management of cardiovascular disease in primary care
- Lignes directrices simplifiees sur les lipides: Prevention et prise en charge des maladies cardiovasculaires en soins primaires
- Challenges faced by primary care physicians when prescribing for patients with chronic diseases in a teaching hospital in Malaysia: a qualitative study
- Frailty: Identifying elderly patients at high risk of poor outcomes
- Health Coaching by Medical Assistants to Improve Control of Diabetes, Hypertension, and Hyperlipidemia in Low-Income Patients: A Randomized Controlled Trial
- La fragilite: Detecter les patients ages a risque eleve d'issues defavorables
- Collaborateurs aux lignes directrices en soins primaires: Quelles sont leurs professions et combien sont en conflit d'interets?
- Contributors to primary care guidelines: What are their professions and how many of them have conflicts of interest?
- Back to the Future: Reflections on the History of the Future of Family Medicine
- Checklists as Computer Decision Support at the Point of Care: A Step Forward in the Recognition and Treatment of CKD by Primary Care Physicians
- Defining and advancing ambulatory care pharmacy practice: It is time to lengthen our stride
- Do Clinical Guidelines Still Make Sense? No
- Challenges to implementing expanded team models: lessons from a centralised nurse-led cholesterol-lowering programme
- Value-Based Financially Sustainable Behavioral Health Components in Patient-Centered Medical Homes
- Oncologists' and Primary Care Physicians' Awareness of Late and Long-Term Effects of Chemotherapy: Implications for Care of the Growing Population of Survivors
- Patients With High-Cost Chronic Conditions Rely Heavily on Primary Care Physicians
- Relationship Quality and Patient-Assessed Quality of Care in VA Primary Care Clinics: Development and Validation of the Work Relationships Scale
- Physician Assistants And Nurse Practitioners Perform Effective Roles On Teams Caring For Medicare Patients With Diabetes
- Caring for Patients with Multiple Chronic Conditions: Balancing Evidenced-based and Patient-Centered Care
- Pharmacy's bucket list: Lean in
- Shared Decision Making, Contextualized
- Performance of Primary Care Physicians and Other Providers on Key Process Measures in the Treatment of Diabetes
- The IMPACT clinic: Innovative model of interprofessional primary care for elderly patients with complex health care needs
- The Primary Care Perspective on Routine Urine Dipstick Screening to Identify Patients with Albuminuria
- In The Netherlands, Rich Interaction Among Professionals Conducting Disease Management Led To Better Chronic Care
- Estimating a Reasonable Patient Panel Size for Primary Care Physicians With Team-Based Task Delegation
- Impact of a Wellness Portal on the Delivery of Patient-Centered Preventive Care
- Share the Care™: Building Teams in Primary Care Practices
- Responsibility of sport and exercise medicine in preventing and managing chronic disease: applying our knowledge and skill is overdue
- Patient-Reported Care Coordination: Associations With Primary Care Continuity and Specialty Care Use
- Home Blood Glucose Monitoring in Type 2 Diabetes: Broken health care system undermines study's impact
- Family Medicine Outpatient Encounters are More Complex Than Those of Cardiology and Psychiatry
- Implications of Reassigning Patients for the Medical Home: A Case Study
- Encounter Frequency and Blood Pressure in Hypertensive Patients With Diabetes Mellitus
- Redesign of a Diabetes System of Care Using an All-or-None Diabetes Bundle to Build Teamwork and Improve Intermediate Outcomes
- Can family physicians practise good medicine without following clinical practice guidelines?: YES
- Les medecins de famille peuvent-ils exercer une bonne medecine sans suivre les guides de pratique clinique?: OUI
- Will Hypertension Performance Measures Used for Pay-for-Performance Programs Penalize Those Who Care for Medically Complex Patients?
- Spain: a decentralised health system in constant flux
- Offering Annual Fecal Occult Blood Tests at Annual Flu Shot Clinics Increases Colorectal Cancer Screening Rates
- Confronting The Growing Burden Of Chronic Disease: Can The U.S. Health Care Workforce Do The Job?
- Chronicity and complexity: Is what's good for the diseases always good for the patients?
- The Gordian Knot of Chronic Illness Care
- Improving Chronic Kidney Disease Care in Primary Care Practices: An Upstate New York Practice-based Research Network (UNYNET) Study
- Who has time for family medicine?
- Global Health and Primary Care Research
- Formation of a primary care pharmacist practice-based research network
- The Missing Link: Improving Quality With a Chronic Disease Management Intervention for the Primary Care Office
- The Teamlet Model of Primary Care
- Diagnostic scope of and exposure to primary care physicians in Australia, New Zealand, and the United States: cross sectional analysis of results from three national surveys
- Competing Demands or Clinical Inertia: The Case of Elevated Glycosylated Hemoglobin
- Future Supply and Demand for Oncologists : Challenges to Assuring Access to Oncology Services