Primary care coordination is more difficult for patients who see many specialists
A patient's high use of specialty care may strain the ability of primary care clinicians to coordinate care effectively, suggests a new study. It found a positive association between primary care continuity and care coordination among patients who had nine or fewer specialty care visits in a year. An increase of 1 standard deviation in continuity measure ranging from 0 to 1 was associated with an increase of 2.71 in patient-reported coordination of care. However, this relationship was not observed in patients with 10 or more specialty care visits in a year.
The researchers conclude that visit-based continuity in the primary care setting is not sufficient to facilitate care coordination for complex patients with high specialty care use. They call for more research on protocols that allow for appropriate specialty referrals, but do not diminish the ability of the primary care physician to manage overall patient care. Examples might include formal service agreements, electronic referrals, nurse support, and adequate visit time.
Findings were based on utilization data and responses to questionnaires mailed to Medicare enrollees receiving care from Group Health, an integrated health care delivery system. All of the 2,051 respondents in the final analysis were age 65 or older, had at least one chronic health condition, and had three or more primary care visits during the study year. The study was supported in part by the Agency for Healthcare Research and Quality (HS13853).
See "Patient-reported care coordination: Associations with primary care continuity and specialty care use," by David T. Liss, M.S., Jessica Chubak, Ph.D., Melissa L. Anderson, M.S., and others in the July/August 2011 Annals of Family Medicine 9(4), pp. 323-329.
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