Progress Remains Slow on Physician/Patient Care Coordination

Ken Terry

June 23, 2016

Healthcare delivery reform and the widespread adoption of health information technology have begun to improve care coordination and the quality of care, but the impact has been limited so far, a new survey indicates.

Sponsored by the Council of Accountable Physician Practices (CAPP), an advocacy organization of medical groups and health systems committed to physician-led accountable care, the survey was conducted by Nielsen Strategic Health Perspectives, which interviewed 30,007 consumers in March. Physician data included in the report was taken from Nielsen's 2015 survey of 626 physicians and previous surveys.

According to the consumer survey results, about half of patients had experienced the help of coordinated care teams. But patients with three or more chronic conditions received only slightly more coordinated care than all patients did. For example, just 37% of patients with multiple conditions said their doctor's office reminded them about appointments or filling prescriptions, compared with 36% of all patients. Just 39% of the chronically ill respondents reported being aided by a care manager versus 37% of all patients.

In many cases, patient information is still not being shared across providers. Sixty percent of patients said their primary care physician (PCP) had access to hospital or emergency room visit records. Forty-nine percent said doctors shared information about their health and knew their history before their visit. And 63% said they could see another provider who had access to their information when their doctor was not available.

A bit more than a third of the patients said they had 24/7 access to care outside of their local hospital's emergency department. But overall access had improved. In 2015, a similar CAPP survey found that 11% of patients saw doctors who had evening and weekend hours; in the recent survey, the percentage was 34%, and 19% of respondents said they'd taken advantage of the expanded access.

In the area of preventive care, just 22% of patients said their PCP had recommended an increase in exercise, while 90% of PCPs said they had done so. Similarly, 19% of patients said they had been advised to improve their diet, while 90% of doctors said they'd recommended that to patients. And 14% of patients said they were generally reminded about preventive screenings, while 89% of physicians said they provided those reminders.

It's well known that patients forget much of what their doctors tell them. Still, it is notable that from 2015 to 2016 the percentage of patients who said their doctors had told them to exercise more, eat better, get preventive screenings, or enroll in a weight-loss program dropped by a few percentage points in each category. Also striking was the fact that only about a third of obese patients said they were advised to exercise more and eat better.

Technology Use

Mobile health apps, which can be used to support preventive and chronic care, also got short shrift. Just 5% of patients said their PCP had recommended using a mobile app to track their physical activity levels versus 52% of PCPs who said they'd done so in the past 12 months. Four percent of patients said their doctor had advised them to use a mobile app to monitor biometric data such as blood pressure and heart rate; in contrast, 45% of the PCPs said they'd done that. Four percent of patients said they were told to use a wearable health monitor to track activity; 40% of the doctors said they'd advised patients to do so.

The report suggested that patients simply didn't hear what their doctors told them. But there may be another explanation. In a Medical Economics survey in fall 2014, over a third of doctors said they had prescribed mobile health apps, but half of those clinicians said they'd just suggested that patients shop in an app store. Very few apps have been rigorously tested for safety and efficacy, and most doctors still don't know what to prescribe.

In other areas, physicians are starting to use technology more to engage patients. Of the doctors surveyed by Nielsen in 2015, 31% said they emailed with their patients; 50% had a patient portal they used to send patients lab results and imaging results; 30% communicated with patients via secure messaging; and 26% sent email appointment reminders to patients. All these numbers represent significant increases above the corresponding figures for 2013 and 2014.

The recent patient survey found that older patients (aged over 65 years) were much less interested in using telephone advice lines than were younger patients. The same was true for online appointment scheduling and text reminders. Even when the entire group of patients was included, just 21% of respondents said they had access to and used telephone advice lines, 22% had and used online appointment scheduling, and 9% had and used texted reminders. Between a third and half of patients who had access to each of these services didn't use them.

"This survey is evidence of the failure of American healthcare to provide coordinated, technologically enabled, high-quality healthcare to the majority of people," said Robert Pearl, MD, chairman of CAPP, and CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group, in a news release. "These findings reinforce CAPP's long-held belief that patient-centered care models are critical to closing the gaps between what patients need and what they are currently receiving."


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