Primary care doctors in the U.S. struggle to coordinate care and communicate with other health and social service providers, according to results from the 2019 Commonwealth Fund International Health Policy Survey, and also published in the journal Health Affairs.
The survey of more than 13,000 primary care physicians in 11 high-income countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States) revealed that although the U.S. leads in several aspects of health information technology, its physicians still face challenges with coordinating care and exchanging information electronically outside their practice. Some of the key findings include:
Primary care doctors in the U.S. trail their counterparts in provider-to-provider communications. While doctors in each of the nations surveyed reported that their practices struggle to coordinate care, the U.S. primary care system falls short in these core areas:
- Communicating with specialists: At least seven in 10 physicians in Norway, France, and New Zealand receive information from specialists about changes to their patients’ medications or care plans. Only 49 percent do in the U.S.
- Emergency department visits: In the U.S., about half of primary care doctors said they are usually notified when a patient is seen in the emergency department (ED). In New Zealand and the Netherlands, more than 80 percent of doctors reported usually being notified about a patient’s ED visit.
- Communication with home care: Communication with home-based nursing care is a problem across countries. Only one-third (33 percent) of U.S. primary care doctors said their practice routinely communicates with patients’ home care providers about patient needs and services. And just 42 percent of U.S. doctors said they are notified by home care providers of changes in their patients’ condition or health status.
What’s more, the research found that U.S. physicians are more likely to offer health information technology to patients, but struggle with interoperability. Amongst the core findings in this area include:
- Patient portals and web-based tools: Overall, U.S. physicians were more likely to report offering their patients these technologies to improve communication and engagement. More than three-quarters (77 percent) of physicians give patients the option of communicating with them via email or a secure website. The use of other technologies—such as video consultations and remote monitoring of patients with chronic conditions—is rare in most countries, but U.S. physicians are among the most likely to use them.
- Physicians from Sweden and the U.S. lead in their use of patient portals to provide appointment scheduling, prescription refills, test results, and visit summaries.
- Interoperability and exchanging information: U.S. physicians faced challenges in exchanging information electronically with physicians outside their practice.
- Only about half of U.S. physicians reported being able to exchange patient clinical summaries, laboratory and diagnostic test results, and patient medication lists with outside physicians. In contrast, most physicians (72 percent to 93 percent) in the Netherlands, New Zealand, Norway, and Sweden reported these abilities.
The data-sharing results from this survey shouldn’t be surprising to industry observers who have been presented with similar research in the past. For instance, a recent Office of the National Coordinator for Health IT (ONC) analysis of American Hospital Association (AHA) data found that just 41 percent of hospitals reported that they were able to engage in all four functions of what the health IT agency classifies as the four domains of interoperability—electronically finding, sending, receiving, and integrating data from outside one’s own organization.
Additionally, in most countries, physicians find it challenging to coordinate with social service providers that offer housing, meals, or transportation.
- Roughly four in 10 physicians in the U.S. (40 percent), Australia (38 percent), and Canada (42 percent) frequently coordinate with patients’ social service and community providers. In contrast, 74 percent of physicians in Germany and 65 percent in the U.K. frequently do so. Physicians in France (21 percent) and Sweden (12 percent) are the least likely to say they frequently coordinate with social service and community providers
- Asked about barriers to coordinating patient care with social services, about one-third or more of U.S. physicians said the following are major challenges: no referral system (31 percent in the U.S.; up to 45 percent in France), inadequate staffing (36 percent in the U.S.; up to 56 percent in the U.K), and no follow-up from social service providers (37 percent in the U.S.; up to 61 percent in the U.K.).
“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,” David Blumenthal, M.D., Commonwealth Fund president, said in a statement. “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 U.S. to incentivize well-coordinated primary care. Because if it isn’t working, patients won’t get the best care possible.”
The report’s authors also added, “Improved technology alone will not suffice. Common ingredients of initiatives across countries include a strong commitment by government and other payers to primary care, the development of innovative care models, and active cooperation among professionals from the health care and social services sectors. Advancing initiatives with these ingredients could improve coordination over time and improve the health of the public without unnecessary increases in cost.”
