Referral and consultation communication between primary care and specialist physicians: finding common ground

Ann S O'Malley, James D Reschovsky
Archives of Internal Medicine 2011 January 10, 171 (1): 56-65

BACKGROUND: Communication between primary care physicians (PCPs) and specialists regarding referrals and consultations is often inadequate, with negative consequences for patients. We examined PCPs' and specialists' perceptions of communication regarding referrals and consultations. We then identified practice characteristics associated with reported communication.

METHODS: We analyzed the nationally representative 2008 Center for Studying Health System Change Health Tracking Physician Survey of 4720 physicians providing at least 20 hours per week of direct patient care. Outcome measures were physician reports of communication regarding referrals and consultations.

RESULTS: Perceptions of communication regarding referrals and consultations differed. For example, 69.3% of PCPs reported "always" or "most of the time" sending notification of a patient's history and reason for consultation to specialists, but only 34.8% of specialists said they "always" or "most of the time" received such notification. Similarly, 80.6% of specialists said they "always" or "most of the time" send consultation results to the referring PCP, but only 62.2% of PCPs said they received such information. Physicians who did not receive timely communication regarding referrals and consultations were more likely to report that their ability to provide high-quality care was threatened. The 3 practice characteristics associated with PCPs and specialists reporting communication regarding referrals and consultations were "adequate" visit time with patients, receipt of quality reports regarding patients with chronic conditions, and nurse support for monitoring patients with chronic conditions.

CONCLUSIONS: These modifiable practice supports associated with communication between PCPs and specialists can help inform the ways that resources are focused to improve care coordination.

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