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Chronic care medicine: Physicians say 'help!'

In a national survey of practicing family physicians, pediatricians, internists and surgeons, the majority reported that their training in chronic care medicine was too thin overall to meet the demands of their practices. Specifically, nearly two-thirds felt poorly trained in skills related to the care of chronically ill patients, including the management of geriatric syndromes, end-of-life care and nutrition.

The Johns Hopkins-led study also found that family practitioners and younger physicians reported more satisfaction with their training, suggesting that medical schools are beginning to address the problem.

"Despite the prevalence and burden of chronic illness, healthcare delivery in the United States is largely organized and financed around acute illness," says Eric Bass, M.D., M.P.H., coauthor of the study, published in the June issue of Academic Medicine, and associate professor of medicine at Hopkins. "As a result, current delivery systems are poorly adapted to the needs of patients with chronic conditions.

"In our study, the majority of practicing clinicians in both primary care and specialty fields had positive attitudes about their ability to care for patients with chronic conditions, but felt they had received less training than needed. Medical educators at all levels should reassess curricula for content on chronic care, ensuring that students get the basics during medical school, and the skills specific to their specialty during residency."

Chronic problems, such as diabetes, heart disease, pain and asthma, account for more than 75 percent of health care spending in the United States, the authors note. More than 80 percent of people over the age of 65 have one or more chronic diseases, and more than 10 percent of children have a chronic condition. Chronic illness here was defined as any condition expected to last a year or longer that limits what one can do and may require ongoing care.

For the study, Bass
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Contact: David March
dmarch1@jhmi.edu
410-955-1534
Johns Hopkins Medical Institutions
27-May-2004


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