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Most Patients Visit PCPs, Not Specialists, for Chronic Care


A majority of patients with high-cost chronic conditions are seeking care from their primary care physicians instead of a subspecialist, according to new data.

A majority of patients seek care for most of 14 high-cost chronic conditions from their primary care physicians, according to data analyzed by the Robert Graham Center for Policy Studies in Family Medicine Primary Care.

The study utilized the 2008 National Ambulatory Medical Care Survey and the Chronic Conditions Dashboard to determine who cared for the patient. Primary care physicians were designated as those in family medicine, general practice, internal medicine or pediatrics.

Manisha Sharma, MD, and colleagues examined outpatient physician visits and found that 85.5% of the visits for asthma occurred in the primary care physician offices, compared to 14% of visits in the subspecialist offices.

Other chronic condition visits to primary care physicians broke down as follows:

• Depression: 53.3% of over 10 million visits

• Chronic obstructive pulmonary disease: 84.5% of over 10 million visits

• Osteoporosis: 66.8% of 5 million visits

• Diabetes: 50.2% of more than 15 million visits

• Chronic kidney disease: 63.6% of nearly 25 million visits

• Hyperlipidemia: 77.9% of more than 30 million visits

• Hypertension: 68.9% of more than 50 million visits.

The only chronic conditions that researchers reviewed data for that did not tip the scales toward primary care physicians were arthritis, atrial fibrillation and ischemic heart disease. For those diseases, patients were more likely to visit a subspecialist.

“Primary care physicians should be referred to as complex care physicians because the burden increasingly falls on them,” Sharma said in a statement. “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.”

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