Lower fragmentation of coordination in primary care is associated with lower prescribing drug costs—lessons from chronic illness care in Hungary

Abstract

Improved patient care coordination is critical for achieving better health outcome measures at reduced cost. Better integration of primary and secondary care in chronic illness care and utilizing the advantages of better collaboration between general practitioners and specialists may support these conflicting goals. Assessing patient care coordination at system level is, however, as challenging as achieving it. Based on prescription data from a private data vendor company, we develop a provider-level care coordination measure to assess the function of primary care at system level. We aim to provide empirical evidence for the possible impact of patient care coordination in chronic illness care-we investigate whether the type of collaborative relationship general practitioners have built up with specialists is associated with prescription drug costs. To our knowledge, no large-scale quantitative study has ever investigated this association. We find that prescription drug costs for patients treated by general practitioners who build up strong collaborative relationships with specialists are significantly lower than for patients treated by general practitioners characterized by fragmented collaborative structures. If future system-level studies in other settings confirm that total healthcare costs are indeed lower for patients treated in strong collaborative structures, then healthcare strategists need to advocate a healthcare system with lower care fragmentation on the interface of primary and secondary care. Regulating access to secondary care might result in significant cost savings through improved care coordination. JEL codes: C12, H51, I18

Scoping review to identify strategies and interventions improving interprofessional collaboration and integration in primary care

“…As the world population is ageing, the growing complexity of healthcare and health needs, together with the associated financial challenges1 and the fragmentation of primary care,2–4 are prompting a fundamental rethink of how primary care should be organised and how professionals in different settings should collaborate 5. As approximately one-third of the world population lives with a chronic disease,6 and as primary care is usually the first point of access to the care system, integrated care at that level in which professionals closely collaborate, both interdisciplinary and interprofessional, is unquestionably important in current and future care organisations.…”

Primary Care Physicians’, Psychiatrists’, and Oncologists’ Coordination While Prescribing Medications for Patients With Multiple Chronic Conditions

“…Coordination of prescribing and interprofessional collaboration have been suggested as solutions to these barriers when caring for patients with MCC 18 . Coordination and collaboration between specialists or interprofessional teams have been associated with reductions in prescription spending, prescribing inappropriate medications, medication errors, and hospital utilization 19–22 . Thus, coordination may improve the appropriateness of prescribing, and patient safety during coordination will likely depend on physicians’ prescribing practices while caring for patients with MCC 22 …”

“…18 Coordination and collaboration between specialists or interprofessional teams have been associated with reductions in prescription spending, prescribing inappropriate medications, medication errors, and hospital utilization. [19][20][21][22] Thus, coordination may improve the appropriateness of prescribing, and patient safety during coordination will likely depend on physicians' prescribing practices while caring for patients with MCC. 22 Our goal is to develop a clearer understanding of what constitutes physicians' coordination of prescribing for MCC.…”