Despite rising health IT adoption, care coordination lags

Survey of primary care physicians in 10 countries find challenges remain
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A survey of primary care providers in 10 countries finds health IT can help improve care, but a large percent of physicians in all countries complained about the time it took to receive information from specialists and hospitals.

U.S. doctors were the most likely to report spending substantial time dealing with insurance restrictions and that their patients often went without care because of costs. As in previous surveys, U.S. physicians were more likely to be dissatisfied with the practice of medicine and to say U.S. healthcare needs to be overhauled.

The survey report by the non-profit Commonwealth Fund appears in Health Affairs.

Physicians in 10 countries--Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, the United Kingdom and the United States--were polled about efforts to achieve the "triple aim" of improving health and patients' experiences while addressing rising costs.

The study focused on patient access, health information technology capacity, communication across sites of care, feedback on practice performance, satisfaction practicing medicine and overall views of the health system.

Among the findings:

  • Just 34 percent of U.S. doctors reported that their practice had after-hours care, compared with at least 89 percent of doctors in Germany, the Netherlands, New Zealand and the United Kingdom
  • 59 percent of U.S. physicians said that their patients often have difficulty paying out-of-pocket costs for medical care. Norwegian, Swiss, and UK doctors were the least likely to say patients often could not afford care.
  • U.S.doctors with high proportions of uninsured or Medicaid patients were the most likely to say that their patients often faced long waits for specialized care.  
  • Two-thirds of Swiss doctors and nearly half of Dutch and German doctors said that their patients could use e-mail to contact them about medical questions or concerns, compared to about one-fourth or fewer doctors in Canada, Australia and Norway.
  • U.S. doctors were generally in the middle of the range of countries on patient ability to get questions answered by email or to request appointments,  referrals or prescription refills online.
  • Nearly all primary care physicians in Australia, the Netherlands, New Zealand, Norway, and the United Kingdom reported using electronic medical records, as they did in the 2009 survey.
  • Though still lagging countries with near-universal adoption, the spread of EMRs has been rapid in the United States and Canada with a 50 percent increase since 2009.
  • Teamwork, communication, and coordination of health care remain major challenges for primary care doctors in all countries.

"Although US health information technology adoption has increased, the study points to the need for intensified efforts to link practice information systems to enable communication and collaboration across care sites. The lack of exchange capacity and U.S. physicians' reports of gaps in communication with specialists and hospitals indicate that there is substantial room to improve," the report states.

Physician dissatisfaction was linked to patients' difficulty in accessing care or being able to afford it – an issue that Medicare handles better than private insurers, according to a previous Commonwealth Fund study.

It also has warned that insurers will have to improve the benefits under individual health plans if they want to remain competitive in 2014 when the reform law's health insurance exchanges go into effect.

To learn more:
- read the report

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