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Better primary care coordination needed in the US

Among 11 high-income countries evaluated for primary care coordination gaps, the United States had the highest rate of poor primary care coordination, suggesting that strengthening the relationship between patients and their primary care physicians is necessary, according to a recent study published in Annals of Family Medicine.

“Effective primary care coordination programs have been shown to reduce hospitalizations, but require patients to have frequent contact with health care professionals and to anticipate needs and communicate information to the right people at the right time,” Jonathan Penm, BPharm, PhD, from James L. Winkle College of Pharmacy at the University of Cincinnati and faculty of pharmacy at the University of Sydney, and colleagues wrote. “Despite these benefits, data measuring the effect of patients’ relationship with their PCP on care coordination are sparse.”

Because care coordination can lead to improving the effectiveness, safety and efficiency of the U.S. health care system, researchers assessed whether population or health care system issues are associated with primary care coordination gaps in the United States. Using data from the 2013 Commonwealth Fund International Health Policy (IHP) survey with multivariate logistic regression analysis, they evaluated adult primary care patients from the United States. and 10 other high-income countries to see if issues experienced in the United States. are due to its unique patient population or health care system.

Researchers found that if patients met at least 3 of the following 5 criteria, they were experiencing gaps in primary care coordination: whether there was a time when test results or medical records were unavailable; they received conflicting information; doctors ordered a test that seemed unnecessary; whether there was a time the specialist did not have basic medical information or test results from the PCP; and if their regular doctor did not seem up-to-date about the care received from specialist.

Based on 13,958 respondents worldwide, the rate of poor primary care coordination was 5.2% overall, with 33% experiencing at least one care coordination gap. Out of 1,395 participants in the United States, the rate was highest at 9.8%. Penm and colleagues found that participants were less likely to experience poor primary care coordination if their PCP often or always knew their medical history, spent time with them and explained things well.

The results showed that patients with chronic conditions and patients aged younger than 65 years were more likely to experience poor primary care coordination, with those aged 25 to 34 years having the highest odds ratio of having poor care coordination (OR 2.3; 95% CI, 1.7-3). Insurance status, household income and sex were not associated with having poor primary care coordination in U.S. patients.

“These differences transcended insurance status and household income, suggesting a systematic issue in the U.S. health care system that distinguishes its efficacy of primary care coordination from that of other countries,” Penm and colleagues wrote. “These results suggest that increased efforts to support relationships between patients and their PCPs are required and that new programs should be designed for a younger, chronically ill population to enhance care coordination.” – by Savannah Demko

Disclosure: Penm reports no relevant financial disclosures.