Editorial board comment
These results are really expected.
If the health care system is focused on quantity of care (number of visits, each focused on a select-narrow problem) you will be able to see many patients but the level of care decreases. This includes processes of care and important collateral influences may not be addressed. When the focus on quantity is decreased, the ability to fully explore the multiple facets of a problem is increased. To be successful at managing chronic disease we will need to move from a system driven by quantity of care to quality of care.
The other finding in this study is that the more often you do a type of care the better you can be at it. I found that when I moved from traditional family medicine to diabetes-centered care I was able to add some efficiencies to my practice, such as a download station, a point-of-care glycated haemoglobin test, templates in my EHR, and fixed orders for labs and immunizations. While this is straightforward in a specialty practice or even a themed practice, it would be too hard to have this level of tools for EVERY single disease that a generalist would see (for example, asthma, chronic obstructive pulmonary disease, diabetes, low back pain, dementia all could have systems of care).
To me this article highlights a couple of things; there is a threshold in which the chronic care quality will go down if the number of visits goes up, and the more you can systematize care the better the processes of care and sometimes outcomes will be.