Patient experiences with coordination of care: the benefit of continuity and primary care physician as referral source

Ann S O'Malley, Peter J Cunningham
Journal of General Internal Medicine 2009, 24 (2): 170-7

BACKGROUND: Coordination across a patient's health needs and providers is important to improving the quality of care.

OBJECTIVES: (1) Describe the extent to which adults report that their care is coordinated between their primary care physician (PCP) and specialists and (2) determine whether visit continuity with one's PCP and the PCP as the referral source for specialist visits are associated with higher coordination ratings.

DESIGN: Cross-sectional study of the 2007 Health Tracking Household Survey.

PARTICIPANTS: A total of 3,436 adults with a PCP and one or more visits to a specialist in the past 12 months.

MEASUREMENTS: Coordination measures were patient perceptions of (1) how informed and up to date the PCP was about specialist care received, (2) whether the PCP talked with the patient about what happened at the recent specialist visit and (3) how well different doctors caring for a patient's chronic condition work together to manage that care.

RESULTS: Less than half of respondents (46%) reported that their PCP always seemed informed about specialist care received. Visit continuity with the PCP was associated with better coordination of specialist care. For example, 62% of patients who usually see the same PCP reported that their PCP discussed with them what happened at their recent specialist visit vs. 48% of those who do not usually see the same PCP (adjusted percentages, p < 0.0001). When a patient's recent specialist visit was based on PCP referral (vs. self-referral or some other source), 50% reported that the PCP was informed and up to date about specialist care received (vs. 35%, p < 0.0001), and 66% reported that their PCP discussed with them what happened at their recent specialist visit (vs. 47%, p < 0.0001).

CONCLUSIONS: Facilitating visit continuity between the patient and PCP, and encouraging the use of the PCP as the referral source would likely enhance care coordination.

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