Østbye Truls, Yarnall Kimberly S H, Krause Katrina M, Pollak Kathryn I, Gradison Margaret, Michener J Lloyd
Department of Community and Family Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Ann Fam Med. 2005 May-Jun;3(3):209-14. doi: 10.1370/afm.310.
Despite the availability of national practice guidelines, many patients fail to receive recommended chronic disease care. Physician time constraints in primary care are likely one cause.
We applied guideline recommendations for 10 common chronic diseases to a panel of 2,500 primary care patients with an age-sex distribution and chronic disease prevalences similar to those of the general population, and estimated the minimum physician time required to deliver high-quality care for these conditions. The result was compared with time available for patient care for the average primary care physician.
Eight hundred twenty-eight hours per year, or 3.5 hours a day, were required to provide care for the top 10 chronic diseases, provided the disease is stable and in good control. We recalculated this estimate based on increased time requirements for uncontrolled disease. Estimated time required increased by a factor of 3. Applying this factor to all 10 diseases, time demands increased to 2,484 hours, or 10.6 hours a day.
Current practice guidelines for only 10 chronic illnesses require more time than primary care physicians have available for patient care overall. Streamlined guidelines and alternative methods of service delivery are needed to meet recommended standards for quality health care.
尽管有国家实践指南，但许多患者仍未得到推荐的慢性病护理。初级保健中医师的时间限制可能是一个原因。
我们将针对10种常见慢性病的指南建议应用于一个由2500名初级保健患者组成的样本，这些患者的年龄和性别分布以及慢性病患病率与普通人群相似，并估计了为这些疾病提供高质量护理所需的最低医师时间。将结果与普通初级保健医师可用于患者护理的时间进行比较。
每年需要828小时，即每天3.5小时，为排名前十的慢性病提供护理，前提是疾病稳定且控制良好。我们根据未控制疾病增加的时间需求重新计算了这一估计值。估计所需时间增加了两倍。将这个系数应用于所有10种疾病，时间需求增加到2484小时，即每天10.6小时。
仅针对10种慢性病的现行实践指南所需时间超过了初级保健医师总体上可用于患者护理的时间。需要简化指南和替代服务提供方式，以达到推荐的优质医疗保健标准。
