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early a quarter of primary care doctors in the United States say their practices are not well-prepared to manage patients with multiple chronic illnesses, according to an international survey.

The 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, released Monday, surveyed doctors in 10 countries, including the United States, Canada, Germany, Australia, and Sweden. Doctors in the United States and Canada felt least prepared among the countries surveyed to handle patients with multiple chronic conditions.

These patients are becoming more common. Aging populations mean more people suffering from degenerative conditions such as dementia and physical frailty. And medical advances have resulted in longer lifespans for people with chronic conditions such as diabetes and heart disease.

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“This global phenomenon is the fruit of the success of improvements [in] medical technology and public health,” said Dr. Eric Schneider, the Commonwealth Fund’s senior vice president for policy and research, and one of the study’s authors.

American doctors’ confidence was especially low in dealing with mental health issues. Only 16 percent of US doctors felt prepared to treat patients with severe mental health problems.

“Primary health care physicians are simply overwhelmed,” said Schneider.

The survey authors highlight some efforts being made under the Affordable Care Act to improve care for these complicated cases. One promising model is the “primary care medical home,” which coordinates efforts between the primary care physician and other medical professionals to manage a patient’s various needs. The researchers also see promise in improved sharing of electronic medical records among health professionals, and in reforms of payment systems.

“We’re still in early days of the Affordable Care Act,” said Schneider. “But it’s designed to strengthen primary care and the treatment of chronic disease. This survey tells us there’s a lot of work to be done.”

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