Care management tools for patients with chronic conditions not always used

The use of care management tools varies widely among primary care physicians who treat patients with chronic conditions, according to a Center for Studying Health System Change report (link).

The study, funded by the Robert Wood Johnson Foundation and released Dec. 16, 2009, analyzed data gathered from more than 4,700 physicians in the center's 2008 Health Tracking Physician Survey. The nationally representative mail survey polled doctors, who provide at least 20 hours per week of direct patient care, on the types of management tools used by their practices.

Physicians were asked if their practices use: written materials for patient education; nurse managers to coordinate care; nonphysician educators; group visits; reports for physicians on the quality of preventive care; reports for physicians on the quality of overall care for patients with chronic conditions; and patient registries.

Overall, 47% of physicians said their practices used two or fewer of the care management tools, while only 4% used six or all seven of the resources.

Most practices, 75%, reported using written materials. However, this may reflect expediency rather than effectiveness, said a co-author of the study, Emily Carrier, MD, senior health researcher for the center, a nonpartisan policy research organization.

"If you're a busy physician, giving an educational pamphlet to your patient is quick and easy. But most researchers think it's less powerful than other, more demanding interventions [which] we found were used much less often," Dr. Carrier said.

Less frequently used were group visits (20%) and nurse managers (31%).

The study highlighted a correlation between practice size and care management tools, with physicians in solo and smaller group practices less likely to use them. The study noted that small practices likely didn't have the financial resources, although insurers and others are beginning to pay for some of these services under a medical-home model.

"Some care management tools are expensive to implement and only make financial sense in larger practices where economies of scale exist," the report stated. "Offering individual practices modest per-patient incentives to adopt care management tools does not address the problem that many of these practices are simply too small to support additional staff or other resources on an ongoing basis."