Care Coordination Vexes US Primary Care Physicians

Marcia Frellick

December 11, 2019

Primary care physicians (PCPs) in the United States trail behind those in other high-income countries when it comes to coordinating care with specialists or social service providers, according to the 2019 Commonwealth Fund International Health Policy Survey.

The news isn't all bad, however; the United States was a leader in providing health technology tools to patients. "Overall, US physicians were among those who more frequently reported offering health IT tools to better communicate with and engage patients," the authors write.

The analysis included survey results from 13,200 primary care physicians from 11 countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States).

Michelle M. Doty, MPH, PhD, vice president of survey research and evaluation at the Commonwealth Fund in New York City, and colleagues published their findings online December 10 in Health Affairs.

In the United States, along with Germany, the Netherlands, and Sweden, only 49% of PCPs or fewer get notified by specialists when their patients' medications or care plans change. In contrast, that happens for at least 70% of PCPs in France, New Zealand, and Norway, and 69% in the United Kingdom.

Whereas 40% of US PCPs frequently coordinate care with social service and community providers, 74% of physicians in Germany and 65% in the United Kingdom make those connections.

In the Netherlands (84%) and New Zealand (85%), when a patient seeks care in an emergency department, most PCPs said they get notified. That compares with approximately half of PCPs (48%) who get such notifications in the United States.

Sharing information and interoperability continue to hamstring US physicians. In the Netherlands, New Zealand, Norway, and Sweden, a range of 72% to 93% of PCPs reported they can share clinical summaries, lab tests, test results, and medication lists while only about half (53%) in the United States can.

Additionally, only 37% of US physicians said they or a provider in their practice made home visits, compared with 70% or more in all the other countries who said they made those visits.

In the United States and Canada, patients were much less likely to be able to see a physician or a nurse after a practice was closed without having to go to the emergency department. In Germany, the Netherlands, New Zealand, and Norway, at least 90% of physicians reported that option was available.

"Ensuring the continuity of care delivered in settings outside the four walls of a primary care practice, but with the involvement of primary care through timely information exchange, is a central prerequisite for coordination," the authors write.

US Leads in Technological Offerings

The United States led the pack in offering health information technology tools to help physician–patient communication and patient engagement.

For instance, 76% of US physicians said their patients could view their test results online, followed by New Zealand (68%), Sweden (68%), and the United Kingdom (52%). Only 2% in Germany and 7% in Australia said their patients could do the same.

The United States also led in the percentage (11%) of physicians who said practices often or usually used remote monitoring for patients with chronic conditions.

In Sweden, 94% of respondents said patients could request medication refills, followed by Norway (91%), the United Kingdom (91%), and the United States (73%). Only 6% of respondents in France and 9% of those in Canada said patients had that option.

US Should "Take Steps" to Improve Care Coordination

The authors point out that the United States is the exception to all the other countries studied who envision a central coordinating role for primary care.

The other countries offer "guaranteed access to primary care that provides after-hours arrangements and gatekeeping to ensure the appropriate use of specialty and other services," they write.

Additionally, "In Australia, Canada, Germany, the Netherlands, and the UK, all or most primary care visits are provided free of charge," they add.

Norway's National Health Network provides secure electronic exchange of patient information and provides secure telecommunication for general practitioners, dentists, hospitals, nursing homes, pharmacists, and others.

Another country setting an example is New Zealand, where PCPs can transfer patients' records securely between practices, get hospital discharge summaries, and make electronic referrals.

David Blumenthal, MD, MPP, president of the Commonwealth Fund, said in a news release, "As a physician who practiced general medicine for 35 years, I know the value of primary care and have experienced many of the challenges described in this survey. While many countries across the globe struggle to deliver all the components of good primary care, many others have developed innovative solutions. We should learn from one another and take steps here in the US to incentivize well-coordinated primary care."

The study was supported by the Commonwealth Fund. The authors have disclosed no relevant financial relationships.

Health Aff. Published online December 10, 2019. Full text

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