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Primary Care Research
Teamwork Within a Practice Can Relieve Patient Overload
By News Staff
- Primary care physicians in the United States are experiencing an increase in the size of their patient panels.
- This is happening at the same time that the country is experiencing a shortage in primary care physicians.
- A new study looks at how delegating varying percentages of tasks associated with patient care to nonclinician team members may help solve the problem.
The researchers calculated that it would take one physician
- 1,773 hours per year (0.71 hours per patient) to deliver all the preventive services recommended by the U.S Preventive Services Task Force,
- 2,484 hours per year (0.99 hours per patient) to provide necessary health care to patients with chronic conditions, and
- 888 hours per year (0.36 hours per patient) to provide acute care to the panel of 2,500 patients.
Creating Models of Care
The first model that incorporates delegation would delegate 77 percent of preventive care and 47 percent of chronic care to nonclinical team members. In this model, a physician cares for a panel of 1,947 patients and spends -- per patient, per year -- 0.16 hours on preventive care, 0.53 hours on chronic care and 0.36 hours on acute care for a total of 1.04 hours.
In the second delegation model, 60 percent of all preventive care time and 30 percent of all chronic care services are delegated to the team. The patient panel size is 1,523 patients. The physician spends -- per patient, per year -- 0.28 hours on preventive care, 0.70 hours on chronic care and 0.36 hours on acute care for a total of 1.33 hours per patient.
The third delegation model delegates 50 percent of preventive care services and 25 percent of chronic care services to the team. In this model, the physician spends -- per patient, per year -- 0.35 hours on preventive care, 0.75 hours on chronic care and 0.36 hours on acute care for a total of 1.46 hours per patient.
In addition, practices considering team-based care need to take other steps, including
- training nonclinical practice team members,
- mapping the office workflow and individual tasks,
- creating standing orders that allow nonclinician staff members to perform patient care previously provided by the physician, and
- educating patients about team-based care.
"These practices point to a future of high-functioning primary care teams than can ensure health care access and quality for the nation's population with a reasonable work life for physicians and other team members."