TUESDAY, May 31, 2005 (HealthDay News) -- Overburdened primary-care physicians are becoming even more overburdened.
That's the conclusion of studies in the May/June issue of the Annals of Family Medicine, which found that there simply aren't enough hours in the day for many family doctors to deliver high-quality care to people with chronic conditions.
Even more troubling, the researchers say, an increasing number of people are now living with more than one of these chronic conditions, which include asthma, diabetes and high blood pressure.
"Diseases tend to run in packs, especially as patients get older and we do a better job of keeping them older," said Dr. James Underberg, a clinical assistant professor of medicine at New York University School of Medicine. "It puts a tremendous amount of stress on physicians to deal with these different diseases. You can't just examine one disease in the context of itself. You have to look at it in the broader sense, and that's the problem."
Underberg cited the example of erectile dysfunction, which used to be treated as an entity unto itself. Now, the disorder has been linked to depression, hypertension and other serious conditions. "You've gone from a three-minute discussion to a 45-minute discussion, and all this is heaped on the lap of the primary-care provider," he explained.
The authors of the first study developed a model to study the time requirements doctors typically need to address 10 common, serious chronic diseases including diabetes, depression, asthma and high blood pressure.
Using U.S. Census Bureau data, they then devised a "virtual" primary-care practice of 2,500 patients with the same prevalence of these chronic diseases as exists in the general population. Each patient was given 10 minutes per chronic disease per doctor's visit.
Using established guidelines for number of visits each year, the authors calculated that a physician would have to spend 3.5 hours a day to provide quality care, as long as the diseases were under control. If the diseases were not well-managed, the doctor needed to spend 10.6 hours. This already exceeded the total time available in a physician's typical workday by 27 percent, the researchers pointed out.
"Now we're getting into requirements that are quite unreasonable, because we are already talking about more hours than the doctor has available, and they are also supposed to be doing preventive and acute care," said study author Dr. Truls Ostbye, a professor of community and family medicine at Duke University Medical Center.
Ostbye's team set forth a number of suggestions to ameliorate the problem, including writing patient care guidelines with real-world conditions in mind.
"There is a lot to be said for having guidelines, but it seems they are often written in isolation," Ostbye said. "They are not taking into consideration that patients have other diseases at the same time, particularly older people."
There's certainly no shortage of guidelines telling doctors how to spend their time with patients, Ostbye said. "There are an incredible number of disease guidelines; you would be amazed to see how many there are. This is a problem in itself."
"Medicine is amazing in its ability to produce consensus statements and guidelines. We love churning these things out," added Underberg. "For the everyday practicing internist, it's absolutely overwhelming. If you did everything they asked you to do, you'd never go home."
The authors also recommended having the physician delegate certain responsibilities to other staff members such as physician's assistants or health educators, and involving the patient more in his or her own care. "Group visits," where a physician might set aside one day a week for patients with diabetes, for instance, also holds promise, they said. The doctor could address the group about issues of lifestyle and medications while conducting separate physical exams.
The results of a second study echoed those of Ostbye's group. Canadian researchers led by Dr. Martin Fortin, of the Unite de Medicine de Famille, in Chicoutimi, Quebec, reviewed medical records and other data on patients cared for by 21 family physicians. The researchers counted each chronic condition, and rated it by severity.
Ninety percent of almost 1,000 patients had more than one chronic condition, Fortin's team report, and about half of the people in the sample aged 45 to 64 years suffered from five or more chronic conditions.
Again, the authors questioned the way health services are organized, suggesting that guidelines should take into account the rising number of patients with multiple conditions.
More information
The University of Missouri has more on managing a chronic illness.
