Patients With High-Cost Chronic Conditions Rely Heavily on Primary Care Physicians

Background Consistent and standardized coding for chronic conditions is associated with better care; however, coding may currently be limited in electronic medical records (EMRs) used in Canadian primary care.Objectives To implement data management activities in a community-based primary care organisation and to evaluate the effects on coding for chronic conditions.Methods Fifty-nine family physicians in Toronto, Ontario, belonging to a single primary care organisation, participated in the study. The organisation implemented a central analytical data repository containing their EMR data extracted, cleaned, standardized and returned by the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a large validated primary care EMR-based database. They used reporting software provided by CPCSSN to identify selected chronic conditions and standardized codes were then added back to the EMR. We studied four chronic conditions (diabetes, hypertension, chronic obstructive pulmonary disease and dementia). We compared changes in coding over six months for physicians in the organisation with changes for 315 primary care physicians participating in CPCSSN across Canada.Results Chronic disease coding within the organisation increased significantly more than in other primary care sites. The adjusted difference in the increase of coding was 7.7% (95% confidence interval 7.1%–8.2%, p < 0.01). The use of standard codes, consisting of the most common diagnostic codes for each condition in the CPCSSN database, increased by 8.9% more (95% CI 8.3%–9.5%, p < 0.01).Conclusions Data management activities were associated with an increase in standardized coding for chronic conditions. Exploring requirements to scale and spread this approach in Canadian primary care organisations may be worthwhile.

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Utilization of Services by Chronically Ill People in Managed Care and Indemnity Plans: Implications for Quality

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.5034/inquiryjrnl_40.1.57 ◽

2003 ◽

Vol 40 (1) ◽

pp. 57-70 ◽

Cited By ~ 2

Author(s):

Stephen M. Davidson ◽

Harriet Davidson ◽

Heidi Miracle-McMahill ◽

J. Michael Oakes ◽

Sybil Crawford ◽

...

Keyword(s):

Primary Care ◽

Managed Care ◽

Chronic Conditions ◽

Primary Care Physicians ◽

Chronically Ill ◽

Hospital Emergency Department ◽

Hospital Emergency ◽

Utilization Of Services ◽

Managed Care Organizations

Because incentives for managed care organizations favor cost containment, concerns have been raised that quality of care has suffered, especially for chronically ill people. This study compares utilization rates of managed care and indemnity patients with three chronic conditions, using five years of claims records (1993–97) from private plans and Medicare in one market. Findings show that for all three conditions, managed care patients were more likely to see both primary care physicians and specialists within a year, but less likely to use a hospital emergency department or to be an inpatient. Assuming that patients with these illnesses should see a physician annually and that good primary care reduces the need for emergency and inpatient services, it appears that the patterns of care used by chronically ill managed care patients in this market do not reflect lower quality than that received by similar indemnity patients.

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Transition for Youth With Chronic Conditions: Primary Care Physicians’ Approaches

PEDIATRICS ◽

10.1542/peds.110.s3.1315 ◽

2002 ◽

Vol 110 (Supplement_3) ◽

pp. 1315-1321 ◽

Cited By ~ 6

Author(s):

Peter Scal

Keyword(s):

Primary Care ◽

Health Care ◽

Chronic Conditions ◽

Primary Care Physicians ◽

Care Transitions ◽

Transition Services ◽

Professional Organizations ◽

Care Practice ◽

Primary Care Settings ◽

Health Care Transitions

Since the US Surgeon General’s conference on health care transitions in 1989, transition from pediatric to adult-oriented health care for youth with chronic conditions continues to develop as an important issue among youth, parents, and health professionals. Key professional organizations, public agencies, and disease-specific organizations have promoted research on transition and the development of transition services. Although there is evidence of the advancement of the science and practice of transition in the context of subspecialty medical care, the same may not be true for transition in the context of primary care practice. Little has been written about the role of the primary care provider in facilitating transition, and little is published in the medical literature about how transition occurs in primary care settings.

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Primary care during the transition to adult care for adolescents involved with pediatric specialty services: a scoping review protocol

Systematic Reviews ◽

10.1186/s13643-021-01593-w ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Kyleigh Schraeder ◽

Brooke Allemang ◽

Cathie Scott ◽

Kerry McBrien ◽

Gina Dimitropoulos ◽

...

Keyword(s):

Primary Care ◽

Scoping Review ◽

Chronic Conditions ◽

Primary Care Physicians ◽

Neurodevelopmental Disorder ◽

Healthcare Services ◽

Chronic Health Condition ◽

Transition To Adult Care ◽

Adult Care ◽

Specialist Services

Abstract Background Of the 15–20% of youth in North America affected by a chronic health condition (e.g., type 1 diabetes, cystic fibrosis) and/or mental health or neurodevelopmental disorder (e.g., depression, eating disorder, Attention Deficit-Hyperactivity Disorder), many often require lifelong specialist healthcare services. Ongoing primary care during childhood and into young adulthood is recommended by best practice guidelines. To date, it is largely unknown if, how, and when primary care physicians (PCPs; such as family physicians) collaborate with specialists as AYAs leave pediatric-oriented services. The proposed scoping review will synthesize the available literature on the roles of PCPs for AYAs with chronic conditions leaving pediatric specialty care and identify potential benefits and challenges of maintaining PCP involvement during transition. Methods Arksey and O’Malley’s original scoping review framework will be utilized with guidance from Levac and colleagues and the Joanna Briggs Institute. A search of databases including MEDLINE (OVID), EMBASE, PsycINFO, and CINAHL will be conducted following the development of a strategic search strategy. Eligible studies will (i) be published in English from January 2004 onwards, (ii) focus on AYAs (ages 12–25) with a chronic condition(s) who have received specialist services during childhood, and (iii) include relevant findings about the roles of PCPs during transition to adult services. A data extraction tool will be developed and piloted on a subset of studies. Both quantitative and qualitative data will be synthesized. Discussion Key themes about the roles of PCPs for AYAs involved with specialist services will be identified through this review. Findings will inform the development and evaluation of a primary-care based intervention to improve transition care for AYAs with chronic conditions.

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Exercise Referral in Germany

Swiss Sports & Exercise Medicine ◽

10.34045/ssem/2014/12 ◽

2014 ◽

Vol 62 (2) ◽

Cited By ~ 1

Keyword(s):

Physical Activity ◽

Primary Care ◽

Health Care ◽

Medical Association ◽

Chronic Conditions ◽

Primary Care Physicians ◽

Federal States ◽

German Medical Association ◽

National Quality ◽

Exercise Referral

Primary care physicians in Germany are potentially in a pivotal position to provide physical activity counselling and exercise referral for their patients. The preventative prescription scheme dates back to the late 1970s. This scheme called “green prescription” (Grünes Rezept), however, could not be established as exercise referral scheme in primary care on a regular and systematic basis. After the German Medical Association (Bundesärztekammer), the German Association for Sports Medicine and Prevention (Deutsche Gesellschaft für Sportmedizin und Prävention) and the German Olympic Sports Federation (Deutscher Olympischer Sportbund) had developed the standardized national quality criteria of Physical Activity on Prescription in a joint effort, the German Medical Association has adopted them in 2011 and now recommends them to the Medical Associations of the Federal States for implementation. These national criteria establish a framework, but given the federal structure of Germany, schemes are not implemented in a uniform or centralized way. The federal states rather develop their own delivery methods according to local possibilities and needs. Exercise as a therapeutic means in the rehabilitation phase of a large number of chronic conditions as well as for people with disabilities is a legally established part of health care. The current legal and financial bases as well as the level of institutionalised support for the prescription of physical activity and exercise within health care are markedly different in the areas of prevention and therapy, respectively. While patients with chronic conditions are entitled to receive free exercise as a means of therapy (within certain limitations), no such “right” exists in the area of prevention. Exercise referrals rely on group offers with defined high standards in organised sports, making use of easily accessible sport clubs which are a traditional part of community life. Rigorous scientific evaluations are needed to provide guidance on how to further develop Germany´s exercise referral schemes.

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Primary Care Physicians’, Psychiatrists’, and Oncologists’ Coordination While Prescribing Medications for Patients With Multiple Chronic Conditions

Journal of Patient Safety ◽

10.1097/pts.0000000000000838 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Cassidi C. McDaniel ◽

Chiahung Chou ◽

Christina Camp ◽

Natalie S. Hohmann ◽

Tessa J. Hastings ◽

...

Keyword(s):

Primary Care ◽

Chronic Conditions ◽

Primary Care Physicians ◽

Multiple Chronic Conditions

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PS218 Education Programs for Primary Care Physicians: An Experience From Various Capacity Building Initiatives on Chronic Conditions in India

Global Heart ◽

10.1016/j.gheart.2016.03.175 ◽

2016 ◽

Vol 11 (2) ◽

pp. e50

Author(s):

P. Gupta ◽

S. Sinha ◽

M. Joshi ◽

S. Vats ◽

M. Sharma ◽

...

Keyword(s):

Primary Care ◽

Capacity Building ◽

Chronic Conditions ◽

Primary Care Physicians ◽

Education Programs

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Multiple Chronic Conditions and the Aging of America

Journal of Primary Care & Community Health ◽

10.1177/2150131911414577 ◽

2011 ◽

Vol 3 (1) ◽

pp. 51-56 ◽

Cited By ~ 24

Author(s):

William S. Pearson ◽

Kavitha Bhat-Schelbert ◽

Janice C. Probst

Keyword(s):

Primary Care ◽

Healthcare System ◽

Burden Of Disease ◽

Chronic Conditions ◽

Primary Care Physicians ◽

Cost Effective ◽

The United States ◽

Assistive Devices ◽

Multiple Chronic Conditions ◽

The Impact

Background: As the United States population ages, chronic conditions are becoming more prevalent and our healthcare system is faced with increasing costs. This aging population with increased multiple chronic conditions coupled with increased burden of disease will provide a challenge to primary care physicians to provide quality care that is cost-effective. Therefore, we examined national data to study the impact of chronic conditions, age and caregiving on lifestyle burden. Methods: Cross-sectional data from the 2009 Behavioral Risk Factor Surveillance System were analyzed for the presence of 9 chronic health conditions, including angina/coronary heart disease (CHD), arthritis, asthma, cancer, diabetes, heart attack, hypertension, obesity, and stroke, and average number of chronic conditions among persons 50 years of age and older. Lifestyle burden, measured by activity limitation, required use of assistive devices, and/or serving in a caregiving capacity was measured and stratified by number of chronic conditions. Results: All conditions except obesity and asthma increased with each age category. By age 70, the majority of adults had hypertension (60.7%) and arthritis (55.0%). Prevalence of activity limitations and use of assistive devices increased as did the numbers of chronic conditions. Discussion: These findings point to a changing population of patients for primary care physicians that will require treatment of multiple chronic conditions as well as increased burden of disease. As this population grows, workloads for primary care physicians will increase and could likely lead to inefficient care and possibly inadequate payment for the required level of management. Therefore, the current challenge facing our healthcare system is to evaluate existing models of care for older patients and to develop new models that are cost-effective while at the same time providing fair reimbursement for increased management.

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