Chronic Disease Management Crippling Primary Care System

Armen Hareyan's picture

Chronic Diseases and Primary Care

Primary care physicians, faced with an aging population and an increase in chronic diseases, are overwhelmed by the needs of patients with diseases such as high blood pressure, heart disease and diabetes, according to a new Duke University Medical Center study. The Duke researchers call for an overhaul of treatment guidelines and new approaches to the care and management of patients with chronic diseases.

"For the physician who thinks she is overwhelmed, and for the patient who feels like he hasn't had enough time with his doctor, we're here to say, 'You're right.' There's not enough time," said Kimberly Yarnall, M.D., associate professor of Duke's department of community and family medicine.


The Duke study, published in the May/June 2005 issue of the Annals of Family Medicine, said the growing strain of chronic diseases on the health care system leaves little time for preventive care, acute care or other medical concerns.

The researchers said the health care system should support appropriate alternatives to costly one-on-one sessions between patients and a doctor. Such new approaches should emphasize a team approach among care-givers and could include group classes on disease management; videos that educate patients about diseases and treatments; online support groups for the psychological and emotional toll that some diseases bring; provider-monitored chat rooms for patients with questions; and print materials that patients could read in the comfort of their homes. The researchers cite insurance reimbursement as a major barrier for enacting such practices.

"The primary care system is at a crossroads. We are estimating a physician shortage in the next ten to fifteen years, but the demand for services continues to increase," said Lloyd Michener, M.D., chair of Duke's department of community and family medicine and senior author on the paper. "The status quo is not going to work much longer