posted 11/20/02
Lack of financial and staff resources, poor clinical information systems, physician workload and resistance to change were all barriers to care using best management processes.
Constrained financial resources, lack of staff, poor information systems and
heavy physician workloads prevent many patients with chronic conditions from
receiving care based on the latest management processes, US researchers report
in the October 26th issue of the British Medical Journal.
Dr. Thomas G. Rundall from the University of
California at Berkeley, and colleagues studied how much evidence-based chronic
care management and computer-based clinical data were used in the care of
patients with several chronic conditions. These included asthma, CHF, depression
and diabetes.
Their study was conducted in nine practices
including the Cleveland Clinic, Ohio, the Mayo Clinic, Rochester Minnesota, and
the Permanente Medical Group, Oakland California.
Dr. Rundall's team looked at management processes
including the use of practice guidelines, population disease management, case
management and health promotion activities.
While some practices made use of all these
methods of patient care management, there was a lot of variation between
practices and management of various diseases, they found. Most of the medical
groups used clinical practice guidelines for the conditions studied. However,
less than half of the groups used all of the management processes.
There was also a wide variation in the use of
computer-based information systems between the practice groups, Dr. Rundall's
team notes.
The researchers found that lack of financial and
staff resources, poor clinical information systems, physician workload and
resistance to change were all barriers to care using best management processes.
As one medical director told the authors, "We
have a major problem with overwork in primary care, and it's getting worse. It
is impossible to launch any program that gives physicians more work."
Dr. Rundall and colleagues conclude that "if our findings about the barriers and facilitators for the use of care management processes are supported by large sample studies of medical practices, the future agenda for restructuring practices should include a redesign of work processes to address doctors' concerns about workload, promotion of a culture that supports quality improvement, diffusion of clinical information systems, and a change in the design of providers' financial incentives."
Source: Diabetes In Control.Com: BMJ 2002;325:958-961.
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