WASHINGTON — Patients with complicated, chronic health conditions see primary care physicians more than subspecialists for their care, according to research by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.
A summary of the research, “Patients with High Cost Chronic Conditions Rely Heavily on Primary Care Physicians,” completed by Manisha Sharma, MD, a visiting scholar at the Graham Center and her co-authors, was published in the January-February issue of the Journal of the American Board of Family Medicine.
Sharma examined outpatient physician visits in the 2008 National Ambulatory Medical Care Survey for care provided for each of the 14 high-cost chronic conditions listed in the Centers for Medicare & Medicaid Services Chronic Conditions Dashboard to determine whether the visits occurred in the subspecialist or primary care physician office. She found that 86 percent of visits for asthma occurred in primary care physician offices, compared to 14 percent in subspecialist offices, and 84 percent of visits for chronic obstructive pulmonary disease were in primary care physician offices, compared to 15 percent in subspecialist offices.
“These data demonstrate how much patients depend on primary care physicians to take care of these complex and chronic conditions,” said Andrew Bazemore, MD, MPH, director of the Graham Center. “Many of these patients have multiple chronic conditions, so a physician with expertise in the whole person and the broad range of medical diagnoses is instrumental to ensuring that all their health needs are met.”
Sharma agreed. “Primary care physicians should be referred to as complex care physicians because the burden increasingly falls on them,” she said. “More and more, primary care physicians must not only identify medical needs of patients with chronic conditions, but they also must identify, coordinate, facilitate, and manage issues surrounding and shaping those chronic conditions such as lifestyle behaviors, food access, safety, and social, environmental, and economic conditions — also known as social determinants of health. That’s not simple, primary care medicine. That’s complex care medicine.”
The burden of chronic care visits and complexity of care needed by patients further highlights the need for team-based care, according to Bazemore. Data show that primary care physicians would need an average of 10.6 hours per working day to care for patients with multiple chronic conditions. “Patients need a team of providers who collectively help them to execute treatment plans and to coordinate that care with other providers and community resources,” he said.
The data show:
The Robert Graham Center for Policy Studies in Primary Care and Family Medicine conducts research and analysis that brings a family practice perspective to health policy deliberations in Washington. Founded in 1999, the center is an independent research unit working under the personnel and financial policies of the American Academy of Family Physicians. The information and opinions contained in research from the Graham Center do not necessarily reflect the views or policy of the AAFP.