Patients With Complex Chronic Conditions Turn to PCPs

Marcia Frellick

January 09, 2014

Although the current physician workforce in US outpatient settings is made up primarily of specialists trained in specific chronic conditions, a majority of patients seeking care for some of the costliest conditions are more likely to turn to a primary care physician (PCP), according to a study published in the January-February issue of the Journal of the American Board of Family Medicine.

Manisha Sharma, MD, from the Evergreen Health Cooperative, Baltimore, Maryland, and a visiting scholar at the Robert Graham Center for Policy Studies in Primary Care and Family Medicine in Washington, DC, and coauthors compared the percentages of outpatient chronic condition visits by PCPs with those by specialists in the past year from the 2008 National Ambulatory Medical Care Survey.

They looked at 14 of the costliest conditions identified by the Centers for Medicare & Medicaid Services. Among those conditions for which a large percentage of patients sought out PCPs, including physicians in internal medicine, family medicine, general practice, and pediatrics, were:

  • asthma, at 85.5%;

  • chronic obstructive pulmonary disease, at 84.5%;

  • hyperlipidemia, at 77.9%;

  • hypertension, at 68.9%;

  • osteoporosis, at 66.8%; and

  • chronic kidney disease, at 63.6%.

Although primary care is widely recognized as critical to the success of healthcare reform, the extent to which PCPs are caring for an increasingly chronically ill patient population may be underestimated, the authors write.

"[PCPs] should be referred to as complex care physicians because the burden increasingly falls on them," Dr. Sharma said in a press release. "More and more, [PCPs] 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."

In an accompanying commentary, David Katerndahl, MD, from the Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, said flexibility in chronic care models is essential, as is adequate visit time.

Although many patients with chronic problems will need only a PCP, for patients with severe, complicated medical challenges, specialists can ensure the latest evidence is driving a patient's care.

"But team-based care must be coordinated by a globally focused [PCP]," Dr. Katerndahl writes.

PCPs need to be trained to provide such care and to lead such teams, he notes. "While current residency training does prepare graduates to provide chronic care, it generally does not prepare them to lead multidisciplinary teams," he adds.

Dr. Katerndahl concludes that if PCPs are to become the "cornerstone of complex chronic care," they must be reimbursed appropriately.

The authors and editorialist have disclosed no relevant financial relationships.

J Am Board Fam Med. 2014;27:6-7, 11-12. Article full text, Commentary full text


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.