Communication Failure in Primary Care

Abstract

In a two-physician general practive within 80 km of two university medical centers, there were 4,367 patient visits in six months, from which 233 referrals (5.3%) were made to consultants. All referred patients were accompanied by referral material and a request for follow-up information. The overall rate of receiving follow-up information was 62%. Private specialists provided substantially more follow-up information (78%) than either university-affiliated emergency rooms (48%) or university-affiliated specialty clinics (59%). Patients requiring continuing medical supervision from the referring physician also fared poorly: follow-up information for them was provided only 54% of the time. The timeliness and method of providing follow-up information were examined and believed to be satisfactory when follow-up information was returned.

Follow-up Appointments at Consultation Clinics: Consultants fail in knowing their own Practice

“…Although the medical literature contains many reports about communication between referring physicians and consultants (10,11,(14)(15)(16)(17)(18)(19)(20)(21)(22), little has been written about followed-up patients in consultant practices and no reports were found about their proportion in consultation services in HMO systems.…”

“…S a n d J Prim Health Care 1992: 10 We think that, by performing the collection of data in only 20 days, we reduced the probability of bias due to possible changes in the behavioural communication between primary physicians and consultants.…”

“…However, this practice may generate over utilization of consultation services, causing problems in the primary care system and frustration among family physicians. Cummins et aI (10) comment that when individual clinicians refer a patient to a consultant and then never hear of that patient again, the experience is a frustrating one, thwarting the physician"s natural curiosity and his opportunity for continuing education through the output of consultations. The desired continuity of care in family practice also suffers if patients with chronic conditions do not return from consultations to their primary physicians…”

Chronic Kidney Disease Care in the US Safety Net

“…Contributing to this issue is the inefficiency of the primary–specialty care interface 46, 47 which relies on overworked primary care providers who must plead to have patients seen in an expedited fashion and a limited network of specialists, including nephrologists, who care for uninsured and Medicaid patients. The current referral system often results in duplicate testing and delayed diagnoses, leading to inefficient use of scare specialty resources 48 and unnecessary costs.…”

Improving the Effectiveness of Electronic Health Record-Based Referral Processes

“…Successful coordination of referrals hinges upon effective and timely communication to facilitate information sharing and transfer of patient care responsibilities between outpatient providers [2-10]. However, referral communication related to both provider-provider and provider-patient interactions [3,11-14] is prone to breakdown [2,14-22]. The growing use of referral care [23] suggests the need for improving reliability and efficiency of the referral process to create a greater impact on health care quality.…”