- Health IT integration is a strong suit of primary care doctors in the United States, compared to other countries. However U.S. physicians trail international colleagues in areas such as managing care for chronic-disease and mentally ill patients.
Commonwealth Fund, a foundation supporting research on healthcare policy, revealed those findings Dec. 7 in its 2015 International Health Policy Survey published in the December issue of Health Affairs. The survey analyzes responses from more than 11,000 primary care doctors in Australia, Canada, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.
The report characterizes health IT as a “bright spot” for the U.S., where substantial improvements support better care coordination. In particular, adoption of electronic health record systems is up 15 percent — from 69 to 84 percent — since Commonwealth’s previous survey in 2012.
Additional survey metrics for health IT use among U.S. physicians:
- Forty-two percent can electronically exchange information with doctors outside their practices, up from 33 percent in 2012.
- Sixty percent of respondent U.S. physicians allow patients to access their medical record electronically, the highest percentage of any country in the survey.
- 47 percent could routinely receive computerized reminders for guideline-based interventions or screening tests in 2015, as compared to 33 percent three years prior.
At the same time, however, among U.S. physicians reporting use of an EHR, only 52 percent said they were very satisfied or satisfied with the system in 2015. That was the second-lowest satisfaction level among the countries surveyed, trailing only Sweden (37 percent).
Preparedness for delivering care
The report notes that, despite being a younger nation overall, the U.S. has a higher share of patients with chronic illnesses than any of the other nine nations surveyed. That demographic signals trouble ahead — especially given that 24 percent of U.S primary care practices say they are not well prepared to manage care for patients with multiple chronic illnesses, and 84 percent are not ready to treat severely mentally ill patients.
“It’s concerning that one in four U.S. primary care doctors don’t think their practices are prepared for the sickest patients, especially when we have so many Americans with multiple chronic illnesses who may get sicker as they age,” said Robin Osborn, lead author of the study and vice president of the International Program in Health Policy and Practice Innovations at The Commonwealth Fund, in a public statement. “To be sure there is affordable, high-quality healthcare for sick and complex patients, we need to continue to strengthen primary care in the U.S.”
The survey findings also show that surveyed physicians in all nations face challenges in coordinating care. In the U.S., only about one-third of primary care doctors said they were always notified when a patient was discharged from a hospital or was seen in an emergency department. The Netherlands recorded the highest areas of notification, 68/69 percent (discharge/ER), while Sweden had the most difficulty, 8/6 percent.
In addition, only about half of U.S. doctors said their practice routinely communicated with patients’ home care providers. The rate fell to 43 percent for communication with social service providers, the lowest among all surveyed countries.
“Primary care is the hub of patients’ health care experiences. If it isn’t strong and working efficiently, patients won’t get the best possible care,” said Commonwealth Fund President David Blumenthal, MD. “Taking steps to encourage doctors, nurses, and social service providers to work together in teams, making it easier for patients to get care on nights and weekends, and facilitating better communication between providers are essential to creating better primary care.”