At a time when chronic diseases have become more widespread and are often poorly controlled, a cluster of three articles in the current issue of Annals tackles important questions about comorbidity and chronic disease. Collectively, they make a compelling argument for a health care system that integrates, rather than fragments, care. A study by Fortin and colleagues defines the extent of the problem, finding that comorbidity is the rule rather than the exception in primary care. A second study out of Duke University Medical Center concludes that it is ineffective, inefficient and impossible to provide appropriate care one disease at a time. Despite this, research in this issue by Barbara Starfield and colleagues out of Johns Hopkins School of Public Health shows that older people with multiple conditions are more likely to get their care from specialists rather than primary care physicians, whose primary role is to integrate the care of the whole person. Collectively, the findings call into question the very organization of our health services. The authors challenge policy makers to consider the staggering extent of comorbidity within the population in any attempt to reengineer primary care.

PRIMARY CARE PHYSICIANS DON'T HAVE ENOUGH TIME TO PROVIDE RECOMMENDED CARE FOR PATIENTS WITH CHRONIC DISEASES
Current practice guidelines for only ten chronic illnesses require more time than primary care physicians have available for patient care overall. Applying guideline recommendations for ten common chronic diseases to a panel of 2,500 primary care patients, researchers found that 3.5 hours a day were required to provide care for these diseases, assuming the conditions were in stable and good control. When accounting for patients whose illness was poorly controlled, the time demand for chronic disease care increased to more than 10 hours per day - exceeding the total amount of physician time available for patient care by 27 percent.

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Contact: Angela Lower
alower@hotmail.com
913-906-6253
American Academy of Family Physicians
31-May-2005

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