DURHAM, N.C. -- Primary care physicians do not have the time to offer needed preventive health care to their patients, says a new Duke University Medical Center study.
According to the study published in the April 2003 issue of the American Journal of Public Health, providing the recommended preventive maintenance for patients would take an estimated 7.4 hours out of a primary care physician's day, leaving approximately 30 minutes for critical and chronic disease care.
"We know that prevention is very important for the health of our nation," said Kimberly Yarnall, M.D., lead author of the study. "But what our study showed was that given the large number of recommendations -- everything from cancer screening to lifestyle counseling -- coupled with the large number of patients that most physicians are responsible for, it is simply not possible for physicians to deliver all those services to their patients. It's a big problem."
Yarnall said that the average patient in a family practice waiting room needs 25 preventive services that have been recommended by the U.S. Preventive Services Task Force. Recommended services vary depending on age, sex, chronic disease status and gestation. Frequency of the services also varies from patient to patient.
Using these recommendations, the Duke researchers assigned conservative time values to the tasks. They estimated the average number of patients a physician sees in a year to be 2,500 and used U.S. Census figures to model a patient panel with an age and sex distribution similar to that of the U.S. population, including children. Chronic disease statistics and pregnancy rates were also factored into the model. The calculations dramatically showed what Yarnall said doctors and patients have been reporting for years: that there is not enough time for all of the recommendations.
"Most would assume that the answer is to pare down the recommendations," said Yarnall, "but even if we slashed the recommendations in half, it would still take half of every day, or half of every visit, to do half of what is now recommended. Prevention is critical, particularly since chronic disease rates in American adults and children are on the rise."
Yarnall also said that the problem will become worse as baby boomers age and as new genetic tests become available.
Lloyd Michener, M.D., senior author on the study and chair of Duke University Medical Center's department of community and family medicine, said that the solution to the problem of inadequate time for preventive care lies in creating a new health-care model that uses a team of caregivers.
The team approach, which Duke has been using for more than 20 years, ensures that patients receive the preventive care they need in addition to acute care and chronic disease management, said Michener. Health-care providers on the team would include nurse practitioners, physician's assistants, nutritionists and health educators.
"By working together, we can offer the patient better care," said Michener. "When we relieve physicians of the sole responsibility for prevention, we can free them up to handle more complicated disease management and acute care. Patients will have more time to discuss complex issues of care, while still receiving the quality preventive care that they need."
The Duke researchers cited as an example of a team approach the management of a patient at risk for heart disease. The patient has high cholesterol and a father who had a heart attack before age 55. Rather than take the estimated eight minutes reported in the study to discuss the importance of a healthy diet with the patient, the doctor might refer the patient to a nutritionist or to a nutrition class. The doctor then has time to discuss any acute care issues, the patient has time to ask questions, and the nutritionist will offer a much more comprehensive explanation of the diet on cholesterol and heart disease.
"It's win-win for everyone," said Yarnall. "We believe preventive maintenance is extremely important; no one would argue that. But doctors do not have the time to do it all. With this model, patients get the information they need and we can all feel confident that people are getting the care and attention they need to develop and keep healthier lifestyles."