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Supplement: The Future of Primary Care |

Chronic Illness Management: What Is the Role of Primary Care?

Arlyss Anderson Rothman, PhD, MHS; and Edward H. Wagner, MD, MPH
[+] Article and Author Information

From University of California, San Francisco, San Francisco, California; and Group Health Cooperative, Seattle, Washington.


Potential Financial Conflicts of Interest:Employment: E.H. Wagner; Grants received: E.H. Wagner.

Requests for Single Reprints: Jonathan A. Showstack, PhD, MPH, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94118-1944.

Current Author Addresses: Dr. Anderson Rothman: University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94118.

Dr. Wagner: Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101.


Ann Intern Med. 2003;138(3):256-261. doi:10.7326/0003-4819-138-3-200302040-00034
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An estimated 99 million Americans live with a chronic illness (1). Through improved knowledge and treatment, people with chronic diseases are living longer. Meeting the needs of this population is one of the major challenges facing the U.S. health care system today and in the future. This challenge is made more difficult because most chronic illnesses increase in prevalence and severity in old age, and treatment includes advance care planning and management of many comorbid conditions. A majority of Americans with major chronic illnesses are probably not receiving appropriate or effective management (2). The consequences are poor disease control, exacerbations, and complications that far exceed those seen with appropriate care. The U.S. Institute of Medicine has described this difference between usual and appropriate care as the “quality chasm” (3).

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