- Despite the high importance currently placed on chronic disease management and patient wellness, most primary care providers say they don’t have enough time to address these issues with their older populations, according to a recent survey from Regina Corso Consulting on behalf of Quest Diagnostics.
These issues leave patients to fend for themselves when it comes to care management and social health needs, the survey results indicated.
The Medicare population – generally patients over 65 – is growing as the baby boomer generation ages into retirement. This has significantly increased the number of patients managing more than one chronic disease, and, in turn, the amount of healthcare dollars spent on chronic disease management.
Seventy-one percent of all healthcare spending is dedicated to chronic care management, and three-quarters of patients over age 65 have more than one chronic condition.
But the healthcare landscape does not currently accommodate meaningful chronic disease management, a survey of about 800 patients and providers showed. The survey revealed that providers simply don’t have enough time to address patients’ healthcare needs.
Additionally, the survey revealed that many patients’ social needs are going amiss because patients are not reporting these issues with their providers.
"Two in three Medicare patients have multiple chronic conditions that require ongoing medical attention and substantial resources from the healthcare system," said Jeffrey Dlott, MD, Medical Director for Chronic Care Management at Quest Diagnostics.
"Our survey findings show that PCPs desperately want to deliver high quality care, but they feel they are failing their patients with the most complex care needs. Patients approve of their primary doctors' care, but are not sharing a litany of social and behavioral issues that, if not resolved in time, could escalate into serious health matters. For some patients, healthcare feels like a solitary journey."
Ninety-five percent of providers said they entered into primary care because they wanted to treat the “whole patient.” However, 85 percent of those providers said they don’t have enough time to address all of their patients’ clinical concerns and 66 percent said they can’t address behavioral and social concerns.
Those behavioral and social concerns, such as loneliness or financial issues, can have significant impact on patients’ ability to be healthy.
But although only 9 percent of providers said they are satisfied with the care their Medicare patients receive, patients showed overwhelming approval. Ninety-two percent of patients said they are satisfied with the level of care they are receiving, which could suggest patients don’t know just how complex their conditions are, the researchers said.
That is not to say patients do not have concerns about their health. Forty-three percent of patients are concerned about developing another chronic disease, while 32 percent are worried about becoming a burden to their loved ones.
Patients also are not sharing their whole story with their clinicians. Two in five patients said they do not tell their doctors about loneliness, isolation, transportation barriers, and other social determinants of health, even though patients said they struggle to stay on top of their own health issues.
The bypass of social determinants of health during primary care encounters may be an issue, the researchers said, because about 80 percent of chronic health conditions can be attributed to the social determinants of health.
In addition to concerns about time and social health needs, primary care providers expressed concern about medication adherence among their chronically ill patients. Eighty-eight percent of providers are concerned that their patients with multiple chronic conditions are not taking their prescribed medications regularly.
Those concerns may be well-founded, as 23 percent of patients admitted that they don’t always take their medications or forget to take their pills. However, only 8 percent of patients said their own medication adherence was a concern.
Reported gaps in care may point to a new path forward for healthcare organizations that are handling a large population of patients with multiple chronic conditions. Eighty-seven percent of primary care providers see value in a chronic disease management program, and 90 percent say medication adherence monitoring would be of benefit to their practices.
But only 23 percent of providers have these kinds of programs. Forty-three percent said complex coding served as a barrier to implementation, while 37 percent said paperwork was a barrier.
Only about half of patient and provider respondents knew these services could be covered by Medicare. While 45 percent of patients said they would be interested in chronic care management services on the whole, that number jumped to 58 percent when they found out chronic care management was a covered Medicare benefit.
These survey results indicate that primary care services need a restructured format. Longer appointment times, an emphasis on both clinical and social health, and better appointment distribution focused on chronic care management could improve the patient-provider relationship.
"Physicians are open to adopting CCM, but it has to be easier to implement and a trusted extension to one's practice," said Katherine A. Evans, DNP, FNP-C, GNP-BC, ACHPN, FAANP, immediate past president of the Gerontological Advanced Practice Nurses Association (GAPNA).
"Older patients are worried about receiving new medical diagnoses and being a burden on caregivers,” she added. “Physicians may explain to patients that CCM can help illuminate emerging health issues before they turn serious, so they can lead independent lives longer. With improved monitoring, these patients may expect a better quality of life."