New Zealand, the Netherlands, and other developed nations are ahead of the United States in care coordination in primary care and community health.
Primary care providers in the United States may struggle with care coordination compared to their peers in similarly developed nations, but nearly all providers are hitting snags coordinating care with social services and community health providers, according to new data from the Commonwealth Fund published in Health Affairs.
The study, published online ahead of its January 2020 print publication, analyzed 13,200 responses to a Commonwealth Fund survey conducted in the United States, the United Kingdom, Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, and Switzerland. Specifically, the survey asked primary care providers about their experiences coordinating care with other medical services and social services organizations that largely attend to the social determinants of health.
Overwhelmingly, the survey revealed that the US is lagging behind in care coordination between both specialty medical services and other social services options, although providers in other developed nations are also struggling with care coordination.
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For example, only 48 percent of US primary care providers receive a notification when their patient has been seen in the emergency department, a far cry from the over 80 percent of providers in New Zealand and the Netherlands who receive the same notifications. Fifty-three percent of American primary care providers are notified when their patient has been admitted into the hospital, compared to 79 percent of providers in New Zealand and 82 percent in the Netherlands said the same.
New Zealand and the Netherlands’ top performances notwithstanding, the study reveals an overall struggle to coordinate care between other medical providers and social services agencies across the globe.
While more than three-quarters of providers in all of the nations surveyed said they send patient histories when referring patients to specialty care, far fewer are receiving notifications from other medical providers.
The United Kingdom, New Zealand, and the Netherlands were outliers in that more than 70 percent of their primary care providers are informed about changes to their patients’ medication regimens. Otherwise, fewer than 60 percent of PCPs around the world receive such notifications, the survey showed.
Less than one-third of primary care providers in any of the surveyed countries can receive updates on patient information within a week, and challenges persist when trying to get information from the ED 48 hours after patient discharge. While over half of providers in Germany (63 percent) and New Zealand (57) percent could get this data, most primary care providers in other countries struggled to coordinate care.
Issues persisted when looking at alternative primary care and chronic care management options, like home-based care or after-hours care in an urgent care or retail clinic.
In New Zealand, 97 percent of primary care providers receive a notification when their patients have visited after-hours care, and 79 percent of providers in the Netherlands could say the same.
Otherwise, fewer than half of all primary care providers in any of the remaining nine surveyed countries said they are notified when their patients are seen after hours.
Similarly, fewer than half of primary care providers in any of the surveyed nations receive notifications about a patient’s home-based care options, whether it be about changes in patients’ healthcare needs or changes to patients’ health status. The US lags behind in both of these categories.
Overall, these disparities in care coordination may be a signal that care access and comprehensive primary care are left wanting in the US, the researchers said. Many of these other developed nations host a coordinated healthcare system in which primary care is the central focus. From there, primary care providers are tasked with managing and coordinating patient access to specialty care.
“With the exception of the US, the surveyed countries have supportive national policies that envision a central coordinating role for primary care, including guaranteed access to primary care that provides after-hours arrangements and gatekeeping to ensure the appropriate use of specialty and other services,” the team wrote.
“In these countries most patients are registered with a named primary care provider who manages referrals to secondary and tertiary care, coordinating use of the larger health care system.”
Strengthening the primary care system in the US could foster a similar approach, the team suggested, eliminating some of the care coordination challenges it sees.
Challenges were exacerbated when coordinating care with community-based care providers and social services, the survey showed. A respectable number of primary care providers from many nations are coordinating with social services, especially in Germany (74 percent), New Zealand (52 percent), Norway (57 percent), and the United Kingdom (65 percent).
In the United States, 40 percent of primary care providers are coordinating care with social services.
But most of the primary care providers in these countries are facing challenges in coordinating with social services. Just about one-third of primary care providers in any of the surveyed nations have a meaningful referral system helping patients access social services, save for France and Austria, both of which see about 40 percent of their providers accessing an adequate referral system.
Nations are also facing challenges staffing these social services referrals and following up with patients after they have accessed a community-based care option. In the US, 36 percent of primary care providers experience staffing shortages and 37 percent report follow-up challenges.
These findings may be the result of community-based care’s recent rise in healthcare prominence. While the social determinants of health have always been at play, providers are just now recognizing the integral role they play in patient wellness and value-based care.
Although a sizeable chunk of providers are working on programs to address community health needs, they do not yet have the infrastructure in place to fully carry out these plans.
“Routine coordination with social service agencies to meet the health-related social needs of patients is a work in progress in most countries except Germany and the UK, where 65 percent or more of physicians reported frequently coordinating with social service providers,” the researchers wrote. “Still, physicians across countries reported major challenges in coordinating patients’ care with social services, such as lacking referral systems, inadequate staffing, and lack of follow-up from social service organizations about patients’ needs.”
Health IT may present one solution for alleviating these challenges, the team recommended. The emergence of EHRs and other technologies are making it easier for providers to document patients who have social services needs. With strong interoperability, providers and social services organizations may be able to integrate their systems, making it easier to coordinate between the two.
But, ultimately, it will require a culture shift to eliminate social services care coordination snags, the team said.
“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,” they concluded. “Advancing initiatives with these ingredients could improve coordination over time and improve the health of the public without unnecessary increases in cost.”
Source: Patient Engagement Hit