Robin Osborn, Donald Moulds, Eric C. Schneider, M.D., Michelle M. Doty, David Squires, Dana O. Sarnak
R. Osborn, D. Moulds, E. C. Schneider et al., “Primary Care Physicians in Ten Countries Report Challenges in Caring for Patients with Complex Health Needs,” Health Affairs, Dec. 2015 34(12):2104–12.
Nearly one-quarter of primary care physicians in the United States report they are not prepared to care for the sickest and frailest patients, and 84 percent say they are not well prepared to manage patients with serious mental illness, according to a new 10-nation survey. The findings suggest the U.S. may need to do more to strengthen primary care and employ new ideas shown to be effective in other countries.
Despite having a younger population than many other developed countries, the U.S. has a higher share of patients with multiple chronic conditions, severe mental illnesses, and other significant health care challenges. As a group, these patients account for a disproportionate share of health care spending, yet they do not fare well—in part because the nation’s primary care practices are ill prepared to meet their needs. The 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians surveyed doctors in 10 countries to compare their experiences in providing care to patients with complex problems, using health information technology, and coordinating care outside of office settings, among other activities.
While U.S. primary care practices lag some other countries in their readiness to manage the care of high-needs patients, the Affordable Care Act has introduced provisions that encourage the health care industry to invest in new ways of providing and paying for health care, such as medical homes and accountable care organizations. These efforts are nascent, however, and delivery systems have been slow to respond to them, the authors note.
Researchers analyzed survey 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. Response rates ranged from 19 percent in Germany to 47 percent in Sweden.
To ensure affordable, high-quality health care for sick and complex patients, the U.S. must strengthen its primary care infrastructure. This includes making it easier for patients to get care on nights and weekends, facilitating communication among providers, and enabling access to social services.