Doctors feel undertrained to care for chronically ill

Physicians don't feel as prepared as they would like when it comes to treating patients with chronic disease, according to a study in the June issue of Academic Medicine.

Two-thirds of doctors in the study felt undertrained in skills tied to care for the chronically ill. But family physicians and younger physicians reported more confidence in these areas than other physicians.

Co-author Eric Bass, MD, MPH, said this is a reflection of how health care in the United States is primarily organized around acute illness, though chronic disease is increasingly pervasive.

"As a result, current delivery systems are poorly adapted to the needs of patients with chronic conditions," Dr. Bass said.

More than 80% of people age 65 and older have one or more chronic diseases, while more than 10% of children have a chronic condition, the authors noted.

Researchers asked a random sample of U.S. physicians about their perceived adequacy in skills related to caring for patients with chronic illness. The authors of "More Training Needed in Chronic Care: A Survey of U.S. Physicians," divided these into 10 areas: management of geriatric syndromes, chronic pain management, nutrition, assessment of developmental milestones in chronically ill children, end-of-life care, management of psychosocial issues related to chronic illness, approaches to patient education, assessment of caregiver needs, coordination of in-home and community services, and interdisciplinary teamwork with nonphysician providers for the chronically ill.

Overall, 60% to 65% of physicians reported that their chronic disease training was less than adequate in all 10 areas. Family physicians were more likely to report adequate training in seven of these areas, and physicians who had trained in the 10 years before the survey also were less likely to report inadequate training.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/06/21/prbf0621.htm.