ArticleAnnals of family medicine
The changing face of chronic illness management in primary care: a qualitative study of underlying influences and unintended outcomes.
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 24 papers, 1 of them a synthesis that pooled it.
What it found
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Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 50 citations in OpenAlex.
- The experience of financial burden for people with multimorbidity: A systematic review of qualitative research.Health expectations : an international journal of public participation in health care and health policy · 2021Pooled it
- Are Corporations Re-Defining Illness and Health? The Diabetes Epidemic, Goal Numbers, and Blockbuster Drugs.Journal of bioethical inquiry · 2021Review
- The factors influencing clinician use of hypertension guidelines in different resource settings: a qualitative study investigating clinicians' perspectives and experiences.BMC health services research · 2021Article
- What are the current 'top five' perceived educational needs of Irish general practitioners?Irish journal of medical science · 2020Article
- Corporate Logic in Clinical Care: The Case of Diabetes Management.Medical anthropology quarterly · 2019Article
- Deprescribing: Practical Ways to Support Person-Centred, Evidence-Based Deprescribing.Pharmacy (Basel, Switzerland) · 2019Article
- How often do both core competencies of shared decision making occur in family medicine teaching clinics?Canadian family physician Medecin de famille canadien · 2019Article
- Safety work and risk management as burdens of treatment in primary care: insights from a focused ethnographic study of patients with multimorbidity.BMC family practice · 2018Article
- Transfer from paediatric to adult care for young adults with Type 2 diabetes: the SEARCH for Diabetes in Youth Study.Diabetic medicine : a journal of the British Diabetic Association · 2018Article
- Exploring the experiences of older Chinese adults with comorbidities including diabetes: surmounting these challenges in order to live a normal life.Patient preference and adherence · 2018Article
- Preparing for the Future of Post-Acute Care: A Metasynthesis of Qualitative Studies.Home health care management & practice · 2017Article
- Patients' expectations of medicines--a review and qualitative synthesis.Health expectations : an international journal of public participation in health care and health policy · 2016Review
- Type 2 diabetes patients' and providers' differing perspectives on medication nonadherence: a qualitative meta-synthesis.BMC health services research · 2015Review
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- Article
- Promoting safe and effective use of OTC medications: CHPA-GSA National Summit.The Gerontologist · 2014Article
- Approach to hypertension among primary care physicians in the West Region of Cameroon: substantial room for improvement.Cardiovascular diagnosis and therapy · 2014Article
- Observational
- The pursuit of preventive care for chronic illness: turning healthy people into chronic patients.Sociology of health & illness · 2014Article
- Deep pharma: psychiatry, anthropology, and pharmaceutical detox.Culture, medicine and psychiatry · 2014Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 1 country.
Funding
Abstract
purposeRecently, there has been dramatic increase in the diagnosis and pharmaceutical management of common chronic illnesses. Using qualitative data collected in primary care clinics, we assessed how these trends play out in clinical care.
methodsThis qualitative study focused on management of type 2 diabetes and hypertension in 44 primary care clinics in Michigan and was based on interviews with 58 clinicians and 70 of their patients, and observations of 107 clinical consultations. We assessed clinicians' treatment strategies and discussions of factors influencing treatment decisions, and patients' understandings and experiences in managing these illnesses.
resultsClinicians focused on helping patients achieve test results recommended by national guidelines, and most reported combining 2 or more medications per condition to reach targets. Medication selection and management was the central focus of the consultations we observed. Polypharmacy was common among patients, with more than one-half taking 5 or more medications. Patient interviews indicated that heavy reliance on pharmaceuticals presents challenges to patient well-being, including financial costs and experiences of adverse health effects.
conclusionsFactors promoting heavy use of pharmaceuticals include lower diagnostic and treatment thresholds, clinician-auditing and reward systems, and the prescribing cascade, whereby more medications are prescribed to control the effects of already-prescribed medications. We present a conceptual model, the inverse benefit law, to provide insight into the impact of pharmaceutical marketing efforts on the observed trends. We make recommendations about limiting the influence of the pharmaceutical industry on clinical practice, toward improving the well-being of patients with chronic illness.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.