Rethinking practitioner roles in chronic illness: the specialist, primary care physician, and the practice nurse
Abstract
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.
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Several patient, physician, and system barriers contribute to the underdiagnosis of anxiety and depression in patients with COPD.
“Several patient, physician, and system barriers contribute to the underdiagnosis of these disorders in patients with COPD.”
From Anxiety and Depression in COPD (2008) · cites this paper as [74]
The collaborative-care model has been found to be associated with marked improvements in the quality of depression care in primary care and significant improvement in depression outcomes.
“In recent years, a model of care termed the collaborative-care model has been found to be associated with marked improvements in the quality of depression care in primary care and significant improvement in depression outcomes.74”
From Anxiety and Depression in COPD (2008) · cites this paper as [74]
Patient barriers include lack of knowledge about the possibility of anxiety or depression and their treatment options.
“Patient barriers include lack of knowledge about the possibility of anxiety or depression as well as their treatment options.”
From Anxiety and Depression in COPD (2008) · cites this paper as [74]
There are several patient-, physician-, and system-level barriers to the detection and management of anxiety and depression in COPD.
“There are several patient-, physician-, and system-level barriers74 (Table 6).”
From Anxiety and Depression in COPD (2008) · cites this paper as [74]
Other patient barriers may include preference for depression care within the primary care system, and therapies that may be limited by insurance coverage or accessibility.
“Other barriers may include preference for depression care within the primary care system, and therapies that may be limited by insurance coverage or accessibility.74”
From Anxiety and Depression in COPD (2008) · cites this paper as [74]
Stigma regarding mental illness may include the belief that depression is a personal and family issue not to be discussed with physicians.
“Stigma regarding mental illness may include the belief that depression is a personal and family issue not to be discussed with physicians.”
From Anxiety and Depression in COPD (2008) · cites this paper as [74]
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References 54 · Cited by 313
- Authors
- Katon, W., Von Korff, M., Lin, E., & Simon, G.
- Affiliations
- University of Washington (US)
- Group Health Cooperative (US)
- Corresponding author
- Katon, Wayne
- ORCID
- Lin, Elizabeth
- Venue
- General Hospital Psychiatry
- Publisher
- Elsevier BV
- Published
- 2001-05
- Volume
- 23
- Issue
- 3
- Pages
- 138-144
- ISSN
- 0163-8343 (ISSN-L)
- OpenAlex
- W1977581755
- Cited by
- 313
- References
- 54
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 6 · 2023: 5 · 2022: 2 · 2021: 9 · 2020: 9 · 2019: 15 · 2018: 8 · 2017: 21 · 2016: 17 · 2015: 7 · 2014: 29 · 2013: 12 · 2012: 15
- FWCI
- 8.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- General Hospital Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH0-11643, MH4-1739)
- Topics
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- chronic disease, stepped care, practitioner role, specialist care, primary care physicians, practice nurses, major depressive disorder, asthma, diabetes mellitus, congestive heart failure
- MeSH terms
- Asthma, Chronic Disease, Cost-Benefit Analysis, Depressive Disorder, Diabetes Mellitus, Family Practice, Health Services Research, Heart Failure, Humans, Job Description, Medicine, Nurse Practitioners, Referral and Consultation, Specialization, United States, Outcome Assessment, Health Care, Cost of Illness, Total Quality Management, Health Care Reform, Community Health Planning, Evidence-Based Medicine, Disease Management, Needs Assessment
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