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Study says not enough time for prevention

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Duke Health News 919-660-1306

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."

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