UC Led Research Finds Poor Primary Care Coordination Higher in U.S.

CINCINNATI—A data analysis study led by University of Cincinnati researchers concluded that the United States lags behind other western, developed nations in providing primary care coordination. Poor primary care coordination, the researchers say, leads to gaps that are associated with medical errors, more follow-up appointments and unnecessary health care spending.

The study, "Minding the Gap: Factors Associated With Primary Care Coordination of Adults in 11 Countries,” appears in the March/April edition of the Annals of Family Medicine and is currently available online.

Primary care coordination is defined in the study as the deliberate organization of patient care activities and sharing information among all of the participants concerned to achieve safe and more effective care.

Per the study, patients were less likely to experience poor primary care coordination if their primary care physician often or always knew their medical history, spent sufficient time, involved them, and explained things well. 

 "Interestingly, poor primary care coordination in the U.S. was not correlated with patients' insurance status, health status, sex, or household income, but was evident with patients who were chronically ill or younger which indicates that a much larger system-level issue may be the cause of poor care coordination in the U.S.,” says Johnathan Penm, PhD, the study’s principal investigator during his fellowship at UC’s James L. Winkle College of Pharmacy.

Penm and fellow researchers at UC evaluated data from a 2013 Commonwealth Fund International Health Policy survey which asked adult patients about their health care experiences. The respondents were from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom and the U.S. 

According to the study, out of 13,958 respondents, the overall rate of poor primary care coordination was 5.2 percent. The individual U.S. rate, however, was 9.8 percent.

This study further confirms the critical role of communication between patients and their primary care providers, says Neil MacKinnon, PhD, dean of the Winkle College of Pharmacy and co-author.  

"All primary care practitioners—whether physicians, nurses, pharmacists or other allied health professions—have a responsibility to ensure that communication is open, meaningful and addresses patient concerns,” says MacKinnon, noting that effective primary care coordination has been shown to reduce hospitalizations.

Implementing these programs, however, can prove challenging. The researchers cite a shortage of primary care physicians, health professional workloads, underfunding of primary care by governments, fragmentation between sectors of health care, and the burden of disease and risk profile of the population as mitigating factors.

"While our country is divided on the next steps post the Affordable Care Act, we should be united on the need to enhance and strengthen primary care coordination,” says MacKinnon.