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Patients with chronic illness not benefiting from advances in care

As good as it gets? Chronic care management in nine leading US physician organisations BMJ Volume 325, pp 958-61


Many patients with chronic diseases are not benefiting from advances in care because of a lack of financial and staff resources, inadequate information systems, and doctors' heavy workload, argue US researchers in this week's BMJ.

They assessed the extent to which evidence-based chronic care management processes and computer based clinical information systems were used to care for patients with asthma, congestive heart failure, depression, and diabetes in nine leading physician practices in the United States.

The care management processes studied were the use of practice guidelines, population disease management, case management, and health promotion or disease prevention activities.

Although they found several examples of high quality care, some of the medical groups used few, if any, care management processes. In some cases care management processes were discontinued because of financial and staffing problems.

Nearly all study groups used clinical practice guidelines for all four chronic conditions. However, the use of other care management processes varied greatly across conditions, with fewer than half of the nine groups using all four processes. The use of computer based information system functions also varied greatly among the groups.

They identified several barriers to the use of care management processes including lack of financial and staff resources, inadequate clinical information systems, doctors' heavy workload and doctors' resistance to change. One medical director said, "We have a major problem with overwork in primary care, and it's getting worse. It is impossible to launch any programme that gives physicians more work."

The future agenda for restructuring practices should include addressing workload issues, promoting a culture that supports quality improvement, expanding clinical information systems, and financial incentives to reward practices that improve the care and outcomes of patients with chronic disease, they conclude.


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