ArticleAnnals of family medicine
How many problems do family physicians manage at each encounter? A WReN study.
Article in Annals of family medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 74 papers.
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Who cites it
74 citing papers in PubMed.
- Trial
- Live well: a practical and effective low-intensity dietary counseling intervention for use in primary care patients with dyslipidemia--a randomized controlled pilot trial.BMC family practice · 2013Trial
- Overwhelmed patients: a videographic analysis of how patients with type 2 diabetes and clinicians articulate and address treatment burden during clinical encounters.Diabetes care · 2012Trial
- Improved delivery of cardiovascular care (IDOCC) through outreach facilitation: study protocol and implementation details of a cluster randomized controlled trial in primary care.Implementation science : IS · 2011Trial
- Impact of EHR-based clinical decision support on adherence to guidelines for patients on NSAIDs: a randomized controlled trial.Annals of family medicineTrial
- Gamified Optimized Diabetes Management With Artificial Intelligence-Powered Rural Telehealth Intervention (GODART): Protocol for an Optimization Pilot and Feasibility Trial.JMIR research protocols · 2025Article
- The Trifecta of Industry, Academic, and Health System Partnership to Improve Mental Health Care Through Smartphone-Based Remote Patient Monitoring: Development and Usability Study.JMIR formative research · 2025Article
- The true complexities of "standard" family practice visits unmasked: an observational cross-sectional study in Regina.Family practice · 2024Observational
- Protocol of a patient randomized clinical trial to improve medication adherence in primary care.Contemporary clinical trials · 2024Article
- Family medicine teaching strategy for managing patients with comorbidity: Collect, cluster, and coordinate.Canadian family physician Medecin de famille canadien · 2023Article
- Unrecognised depression among older people: a cross-sectional study from Norwegian general practice.BJGP open · 2023Article
- The Registrar Clinical Encounters in Training (ReCEnT) cohort study: updated protocol.BMC primary care · 2022Article
- Primary care physicians' electronic health record proficiency and efficiency behaviors and time interacting with electronic health records: a quantile regression analysis.Journal of the American Medical Informatics Association : JAMIA · 2022Article
- Visit Linearity in Primary Care Visits for Patients with Chronic Pain on Long-term Opioid Therapy.Journal of general internal medicine · 2022Article
- Dealing with the Lack of Time for Detailed Shared Decision-making in Primary Care: Everyday Shared Decision-making.Journal of general internal medicine · 2020Article
- Efficiency as a determinant of loyalty among users of a Community of Clinical Practice: a comparative study between the implementation and consolidation phases.BMC family practice · 2020Article
- Clustering and Healthcare Costs With Multiple Chronic Conditions in a US Study.Frontiers in public health · 2020Article
- Article
- Enhancing Immunization Rates in Two Urban Academic Primary Care Clinics: A Before and After Assessment.Journal of patient-centered research and reviews · 2020Article
- Healthcare utilization and management of actinic keratosis in primary and secondary care: a complementary database analysis.The British journal of dermatology · 2019Article
14 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe number of problems managed concurrently by family physicians during patient encounters has not been fully explored despite the implications for quality assessment, guideline implementation, education, research, administration, and funding. Our study objective was to determine the number of problems physicians report managing at each visit and compare that with the number reflected in the chart and the bill.
methodsTwenty-nine members of the Wisconsin Research Network reported on encounters with 572 patients using a physician problem log. The patient chart notes and the diagnoses submitted for billing from the encounters were compared with the information in these logs.
resultsThe physicians reported managing an average of 3.05 problems per encounter and recorded 2.82 in the chart and 1.97 on the bill. For all patients, 37% of encounters addressed more than 3 problems, and 18% addressed more than 4. For patients older than 65 years, there was an average of 3.88 problems at each visit, and for diabetic patients there was an average of 4.60. There was evidence for the selective omission of mental health and substance problems from the diagnoses used for billing.
conclusionsFamily medicine involves the concurrent care of multiple problems, which billing data do not adequately reflect. Our findings suggest a mismatch between family medicine and current approaches to quality assessment, guideline implementation, education, research, administration, and funding. Activities in all these areas need to address the physician's task of prioritizing and integrating care for multiple problems concurrently.
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