Rethinking practitioner roles in chronic illness: the specialist, primary care physician, and the practice nurse.
In this article, we describe an evidence-based stepped care approach to improving the care of chronic illness in organized health care systems. We review the common principles that have been found to improve the management and outcomes of patients with major depression, asthma, diabetes, and congestive heart failure. These population-based methods to improve care of chronic illness require reorganizing the roles of specialists, primary care physicians, and nurses.
Katon
W
W
Department of Psychiatry and Behavioral Sciences, Box 356560 University of Washington Medical School, Seattle, WA 98195, USA. wkaton@u.washingotn.edu
Von Korff
M
M
Lin
E
E
Simon
G
G
D001249:Asthma / Q000628:therapy; D002908:Chronic Disease / Q000628:therapy*; D018672:Community Health Planning; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000628:therapy; D003920:Diabetes Mellitus / Q000628:therapy; D019468:Disease Management; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000458:organization & administration*; D018166:Health Care Reform / Q000458:organization & administration; D006302:Health Services Research; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D007587:Job Description; D008511:Medicine / Q000458:organization & administration*; D020380:Needs Assessment; D009722:Nurse Practitioners / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D012017:Referral and Consultation / Q000458:organization & administration; D013038:Specialization; D017749:Total Quality Management / Q000458:organization & administration*; D014481:United States