Chronic Care in Adulthood and Old Age: Physical and Psychosocial Management in General Practice Encounters

Abstract

Managing chronic physical disease straddles two paradigms of care - the biomedical and the psychosocial. To respond to the challenges of the ageing population with increasing chronic disease, general practitioners need to understand the impact of their collective processes of care. The research objective is to compare general practitioner consultations identified by a diagnosis of chronic physical condition with those with a psychological diagnosis and both chronic physical and psychological diagnoses. The method used is a retrospective analysis of a national sample of general practitioners (GPs) who documented their consultations. In consultations where chronic physical conditions were managed, general practitioners documented few psychosocial or physical support interventions including referrals. These consultations were with an older age group, who had multiple diagnoses with high levels of continuity. This pattern persisted whether or not psychological conditions were also managed in the same encounter. In consultations where psychological diagnoses, without a chronic physical diagnosis, were managed, GPs documented high levels of psychosocial support interventions. General practitioners are less likely to document psychological and physical support care in chronic physical disease consultations than all other types of consultation. This analysis has limitations due to incomplete data and cross-sectional design, however, the study raises questions about the comprehensiveness of care in the past and provides a baseline against which to measure the impact of current reforms for complex chronic conditions.