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Primary Care

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Primary care doctors in California have a positive view of voluntary disease management programs

Chronic conditions such as asthma, diabetes, and congestive heart failure may be better managed when medical care goes hand-in-hand with case management and patient education services provided by nurses or others. Some managed care plans now separate payment for specified chronic illnesses from their primary care contracts, delegating care of these patients to specialist-run disease management programs.

This approach has been criticized as leading to fragmented care if patients with multiple chronic diseases are treated in separate disease-specific programs rather than obtaining comprehensive care from a primary care physician (PCP). However, PCPs in California have a different view; they believe voluntary disease management programs improve the care of patients and reduce physicians' workload, according to a study supported in part by the Agency for Healthcare Research and Quality (HS09557).

The researchers surveyed PCPs practicing in the 13 largest urban counties in California and found that 75 percent of the PCPs believed that disease management programs improved the quality of overall and disease-specific care. Also, 87 percent of PCPs continued to provide primary care for patients enrolled in these programs, and 70 percent reported participating in major patient care decisions. Most of the PCPs (91 percent) reported that the programs had no effect on their income, decreased (38 percent) or had no effect (48 percent) on their workload, and increased (48 percent) their practice satisfaction. Over half (53 percent) of PCPs said they had disease management programs available to them, most commonly programs for diabetes, asthma, congestive heart failure, and AIDS. Only 12 percent of physicians with available disease management programs were required to use them for eligible patients. Yet 57 percent of PCPs not required to enroll patients in disease management programs had them enrolled, demonstrating substantial voluntary participation.

See "Primary care physicians' experience with disease management programs," by Alicia Fernandez, M.D., Kevin Grumbach, M.D., Karen Vranizan, M.A., Dennis H. Osmond, Ph.D., and Andrew B. Bindman, M.D., in the March 2001 Journal of General Internal Medicine 16, pp. 163-167.

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