Meta-analysis: Effect of Interactive Communication Between Collaborating Primary Care Physicians and Specialists

Foy, Robbie; Hempel, Susanne; Rubenstein, Lisa V.; Suttorp, Marika J; Seelig, Michelle D.; Shanman, Roberta; Shekelle, Paul G

doi:10.7326/0003-4819-152-4-201002160-00010

Cited by 163 publications

(157 citation statements)

References 82 publications

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“…30 For example, interactive interventions aimed at improving quality of communication between PCPs and specialty providers may have contributed to improved patient outcomes for diabetes and mental illness. 31 This may explain our finding that eConsults, which create a virtual mechanism for these "hallway conversations," were viewed by PCPs as a positive development that is improving communication with specialists. Further, this need for interaction may explain why PCP-reported strategies to supplement EMR communication were modalities where they interacted more personally with specialists.…”

Section: Discussionmentioning

confidence: 95%

Challenges in Referral Communication Between VHA Primary Care and Specialty Care

et al. 2014

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BACKGROUND:Poor communication between primary care providers (PCPs) and specialists is a significant problem and a detriment to effective care coordination. Inconsistency in the quality of primary-specialty communication persists even in environments with integrated delivery systems and electronic medical records (EMRs), such as the Veterans Health Administration (VHA). OBJECTIVE: The purpose of this study was to measure ease of communication and to characterize communication challenges perceived by PCPs and primary care personnel in the VHA, with a particular focus on challenges associated with referral communication. DESIGN:The study utilized a convergent mixed-methods design: online cross-sectional survey measuring PCPreported ease of communication with specialists, and semi-structured interviews characterizing primary-specialty communication challenges. PARTICIPANTS: 191 VHA PCPs from one regional network were surveyed (54 % response rate), and 41 VHA PCPs and primary care staff were interviewed. MAIN MEASURES/APPROACH: PCP-reported ease of communication mean score (survey) and recurring themes in participant descriptions of primary-specialty referral communication (interviews) were analyzed. KEY RESULTS: Among PCPs, ease-of-communication ratings were highest for women's health and mental health (mean score of 2.3 on a scale of 1-3 in both), and lowest for cardiothoracic surgery and neurology (mean scores of 1.3 and 1.6, respectively). Primary care personnel experienced challenges communicating with specialists via the EMR system, including difficulty in communicating special requests for appointments within a certain time frame and frequent rejection of referral requests due to rigid informational requirements. When faced with these challenges, PCPs reported using strategies such as telephone and e-mail contact with specialists with whom they had established relationships, as well as the use of an EMR-based referral innovation called "eConsults" as an alternative to a traditional referral.CONCLUSIONS: Primary-specialty communication is a continuing challenge that varies by specialty and may be associated with the likelihood of an established connection already in place between specialty and primary care. Improvement in EMR systems is needed, with more flexibility for the communication of special requests. Building relationships between PCPs and specialists may also facilitate referral communication.

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Section: Discussionmentioning

confidence: 95%

Challenges in Referral Communication Between VHA Primary Care and Specialty Care

et al. 2014

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“…Appropriate repatriation could have significant effects on health care costs, care coordination burden, and access, but appears to require changes on several fronts, including: 1) better communication and information sharing between PCPs and specialists, and between clinicians and patients, both of which have been previously shown to be associated with improved health outcomes and care quality [23][24][25] ; 2) strategies that address "perennial follow-up" without undermining the benefits of specialty care to patients; and 3) improving access to PCPs, particularly clinicians with the time and resources to provide comprehensive services for patients with multiple medical conditions. Our results suggest that efforts to support repatriation, where both specialist and PCP agree, will be more likely to succeed if the complex, multi-level factors that influence decisions about the location and duration of patient follow-up care are addressed.…”

Section: Discussionmentioning

confidence: 99%

When to Repatriate? Clinicians’ Perspectives on the Transfer of Patient Management from Specialty to Primary Care

et al. 2014

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“…[35][36][37] We collected relevant local data on communication patterns and barriers. Then we used the results of a systematic review of PC-MH communication 7 and local data to develop and initiate strategies for improvement.…”

Section: Methodsmentioning

confidence: 99%

“…To identify candidate strategies, the work group reviewed interventions for improving communication identified through a prior systematic review of PC-MH communication. 7 Work group members then suggested additional strategies based on barriers listed in the final fishbone and flow charts. Then they completed an anonymous online survey to vote for the most feasible interventions.…”

Section: Methodsmentioning

confidence: 99%

The Anatomy of Primary Care and Mental Health Clinician Communication: A Quality Improvement Case Study

et al. 2014

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BACKGROUND:The high prevalence of comorbid physical and mental illnesses among veterans is well known. Therefore, ensuring effective communication between primary care (PC) and mental health (MH) clinicians in the Veterans Affairs (VA) health care system is essential. The VA's Patient Aligned Care Teams (PACT) initiative has further raised awareness of the need for communication between PC and MH. Improving such communication, however, has proven challenging. OBJECTIVE: To qualitatively understand barriers to PC-MH communication in an academic communitybased clinic by using continuous quality improvement (CQI) tools and then initiate a change strategy. DESIGN, PARTICIPANTS, AND APPROACH: An interdisciplinary quality improvement (QI) work group composed of 11 on-site PC and MH providers, administrators, and researchers identified communication barriers and facilitators using fishbone diagrams and process flow maps. The work group then verified and provided context for the diagram and flow maps through medical record review (32 patients who received both PC and MH care), interviews (6 stakeholders), and reports from four previously completed focus groups. Based on these findings and a previous systematic review of interventions to improve interspecialty communication, the team initiated plans for improvement. KEY RESULTS: Key communication barriers included lack of effective standardized communication processes, practice style differences, and inadequate PC training in MH. Clinicians often accessed advice or formal consultation based on pre-existing across-discipline personal relationships. The work group identified collocated collaborative care, joint care planning, and joint case conferences as feasible, evidence-based interventions for improving communication. CONCLUSIONS: CQI tools enabled providers to systematically assess local communication barriers and facilitators and engaged stakeholders in developing possible solutions. A locally tailored CQI process focusing on communication helped initiate change strategies and ongoing improvement efforts.KEY WORDS: primary care; mental health; communication; quality improvement; ambulatory care; primary care redesign.

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Meta-analysis: Effect of Interactive Communication Between Collaborating Primary Care Physicians and Specialists

Abstract: RAND Health's Comprehensive Assessment of Reform Options Initiative, the Veterans Affairs Center for the Study of Provider Behavior, The Commonwealth Fund, and the Health Foundation.

Cited by 163 publications

References 82 publications

Challenges in Referral Communication Between VHA Primary Care and Specialty Care

Challenges in Referral Communication Between VHA Primary Care and Specialty Care

When to Repatriate? Clinicians’ Perspectives on the Transfer of Patient Management from Specialty to Primary Care

The Anatomy of Primary Care and Mental Health Clinician Communication: A Quality Improvement Case Study

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