J Korean Med Assoc.  2017 Jan;60(1):72-80. 10.5124/jkma.2017.60.1.72.

Duration of and fee for comprehensive assessment and care planning for patients with hypertension and/or diabetes in primary care

• Lee J
• Choi YJ
• An AR
• Kim Y

• KMID: 2367732
• DOI: http://doi.org/10.5124/jkma.2017.60.1.72

Abstract

The enhanced primary care demonstration (EPD) was launched in November 2014 to provide high-quality care for people with chronic illnesses. In the EPD, comprehensive assessment and care planning (CAP) is a critical component, along with behavior modification and case management services. In this study, we measured CAP duration and calculated the fee for CAP sessions performed with patients with hypertension and/or diabetes mellitus. In 5 primary care clinics participating in the EPD, the duration of CAP sessions and usual consultations was measured. The duration of CAP sessions was measured on 2 separate occasions because CAP involves 2 separate consultations, including an initial consultation for comprehensive patient assessment and laboratory testing and a follow-up consultation for creating a care plan based on the assessment and test results. The CAP fee was calculated as the ratio of CAP time to the usual consultation time. The median (interquartile range) and the mean ± standard deviation of CAP duration were 15.4 (7.1) minutes and 15.6 ± 4.2 minutes, respectively. The first and second CAP sessions lasted for 5.3 and 4.6 times longer than usual consultations, respectively. The calculated CAP fees were 76,299 won (median) and 65,766 won (mean). The length of CAP sessions for patients with hypertension and/or diabetes mellitus was approximately 5 times longer than that of usual consultations. If consultation lengths were measured in a representative patient sample, it would be possible to improve the external validity of the measurements.

Keyword

Primary health care; Time; Fees, medical; Diagnosis; Patient care planning

MeSH Terms

Behavior Therapy
Case Management
Chronic Disease
Diabetes Mellitus
Diagnosis
Fees and Charges*
Fees, Medical
Follow-Up Studies
Humans
Hypertension*
Patient Care Planning
Primary Health Care*
Referral and Consultation

Figure

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  Figure 1 A chronic care model for people with hypertension and/or diabetes in primary care. a)Reminder and recall interventions are used.

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  Figure 2 Average consultation length in primary care from selected studies. CAP, comprehensive assessment and care planning; US, United States [12]; AU, Australia [13]; GB, United Kingdom [14]; JP, Japan [16]; CN, China [15].

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