Q&A: Study reveals lack of communication between general practitioners, cardiologists
Communication between cardiologists and general practitioners during the treatment of patients with non-acute chest pain was “suboptimal,” according to researchers.
Simone van den Bulk, MD, a PhD candidate at the Leiden University Medical Center in the Netherlands, and colleagues conducted the study to examine the quality of collaboration between general practitioners (GPs) and cardiologists.
The analysis included 2010 to 2016 data on 9,029 patients in the Netherlands who had no history of CVD but presented to a GP for non-acute chest pain with suspected cardiac origins. Among the patients, 24% were referred to a cardiologist.
Van den Bulk and colleagues found that for 41% of referred patients, correspondence was not found in the GP’s electronic medical records. For 60% of patients with available correspondence, the GP did not code the conclusion in the EMR.
Additionally, among patients with angina pectoris, 15% were not prescribed antiplatelet therapy or anticoagulation, 27% were not prescribed statin therapy and 26% were not prescribed beta-blockers.
Van den Bulk spoke with Healio about the study findings, potential reasons for the lack of communication between GPs and cardiologists and more.
Healio: What did you find interesting or notable about the study?
Van den Bulk: I think what is interesting, and probably not restricted to just cardiology and GPs, is that we tend to point a finger at each other. Cardiologists would say that the GP doesn’t make proper referrals, for example, and the GP would say the cardiologist never reports back to me about what they did or what they found. I found it really interesting to see that on both sides, there is room for improvement when it comes to communication.
With these findings, I hope I can wake up both the cardiologists and GPs and show that besides pointing at each other, we also have to look at ourselves. If we want to have proper communication and good health care continuum, we have to collaborate.
Healio: What are potential reasons for poor correspondence adherence?
Van den Bulk: I think it is because of the high workload in both primary care and secondary care, and just the daily affairs. Things just get forgotten. I can imagine, for example, a cardiologist thinks, “I will write a report back after all the additional diagnostic tests are done, I have a conclusion and I have a plan,” but that maybe takes some time and then it just gets forgotten.
On the other hand, I can also imagine that, especially when there are no specific findings, maybe it doesn’t seem important enough to report back in contrast to when they do have specific findings. As I mentioned in the article, at least in the Netherlands, we have clear guidelines on communication, but maybe cardiologists, specialists and GPs are not familiar with the guidelines.
Healio: Could this study apply to U.S. physicians?
Van den Bulk: I think every country is at risk, so to say, for this problem. It would be interesting to do a study similar in routinely collected health data in the U.S. and see if there is a difference. For example, if you would see that it’s much better in the U.S., it would be interesting to see what we do differently and why it is better in one place than another.
Healio: Where does the research go from here?
Van den Bulk: I think this is just the start. Now we have a little bit of an insight into health care for patients with non-acute chest pain. We defined the problem, and now we have to think of how we’re going to solve the problem. In my department, a colleague is ... developing a project to improve and stimulate the collaboration between primary care and secondary care in these patients, specifically. For example, improving communication, but also deciding who is responsible for the medical treatment of the patients with angina pectoris. Is that the GP or is it the cardiologist? By defining who is responsible, we’re hoping this will also increase guideline adherence. It’s a complex problem, so it will require more complex solutions.