Chronic care medicine: Physicians say 'help!'

and colleagues conducted telephone surveys of 1,236 physicians nationwide regarding the physicians'' attitudes about caring for the chronically ill, and assessing how well they feel they were trained to do so. Interviewees were selected randomly from American Medical Association and American Osteopathic Association member lists.

On average, those interviewed were 46.7 years old and had graduated from medical school 19.4 years prior to taking the survey. Twenty-six percent of the respondents were female and 72 percent were white. Respondents included 270 family or general practitioners, 231 internists, 129 pediatricians, 335 non-surgical specialists and 271 surgical specialists. Twenty-six percent of respondents worked mostly with elderly adults and 24 percent reported that 80 percent to 100 percent of their patients had a chronic medical condition.

Most physicians responded that medical training had a positive effect on their attitudes toward caring for the chronically ill. However, overall, 60 percent to 65 percent of physicians reported that they had not received adequate training in 10 chronic care skills: approaches to educating the chronically ill, end-of-life care, coordination of in-home and community services, management of geriatric syndromes, management of psychological and social aspects of chronic illness, assessment of care giver and family needs for patients with chronic illness, chronic pain management, nutrition, interdisciplinary teamwork with non-physician providers for the chronically ill, and assessment of developmental milestones in chronically ill children.

Family practitioners were less likely than other physicians to report that their training was inadequate. This may be because family practice training is focused more on outpatient care rather than acute care settings, Bass says. In addition, those who graduated from medical school within 10 years of taking the survey also were less likely to report inadequate

Contact: David March
Johns Hopkins Medical Institutions

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