Blog | Tuesday, January 11, 2011

QD: News Every Day--What's happening to handoffs between primary care physicians, specialists?


Far more primary care doctors report detailed referrals than do specialists report receiving them. The same applies in reverse. Specialists report returning quality consultations, while primary care physicians report receiving them far less often.

Researchers reported in Archives of Internal Medicine that perceptions of communication regarding referrals and consultations differed widely. While 69.3% of primary care physicians reported "always" or "most of the time" sending a patient's history and the reason for the consultation to specialists, only 34.8% of specialists said they "always" or "most of the time" received the information. And, while 80.6% of specialists said they "always" or "most of the time" send consultation results to the referring physicians, only 62.2% of primary care physicians said they received it.

So where are the reports going?

Meanwhile, physicians who did not receive timely communications said it affected their ability to provide high-quality care. "The results suggest much room for improvement," the authors wrote.

Practices that reported better communication during handoffs included those with "adequate" visit time with patients, receipt of quality reports about patients with chronic conditions, and nurse support for monitoring patients with chronic conditions. Health information technology helped the specialists, but not the primary care physicians, reflecting that specialists were more likely to work at larger health facilities with more technology at hand.

The study and an accompanying editorial cited changing the fee-for-service model of primary care reimbursement, restructuring the primary care-specialty interface through the patient-centered medical home and accountable care organizations to increase collaboration, and through health information technology.

An editorial went further with the subject. "In the context of health care system reform, these findings provide reassurance that we are on the right track. Escaping the tyranny of the 15-minute visit, using clinical data to improve individual and population health, and practicing team-based care--all supported by the use of a robust [electronic medical record]--are some of the fundamental building blocks of a successful patient-centered medical home. Nevertheless, even when all 4 supports are applied to a [primary care physician] practice, the probability of communication to a specialist only increases from 63.9% to 82.7%. This begs the question, 'Can't we do better?'"