The Issue

A strong primary care system can help prevent illness, manage patient care across multiple providers, and reduce health care costs. Essential to such a system is effective communication. To address patients’ needs, primary care physicians often must communicate and exchange information with specialists, hospitals and other care settings, social service providers — and, of course, the patients themselves.

The Commonwealth Fund surveyed more than 13,000 primary care providers in 11 high-income countries — Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States — to compare their experiences providing extended access to patients through home visits or after-hours care, coordinating care among different providers, and using health information technology. The results of the survey, conducted January to June 2019, are published in the January 2020 issue of Health Affairs.

What the Study Found

  • The U.S. is an outlier in terms of providing extended access to primary care. Only 37 percent of physicians in the U.S. reported making frequent or occasional home visits, compared to 70 percent or more in the other countries. Practices in the U.S. and Canada were also much less likely than those in other countries to provide after-hours care to patients without having to visit an emergency department (ED).
  • U.S. providers trail their counterparts in coordinating care with other doctors. Fewer than half (49%) of U.S. primary care providers receive information from specialists about changes to their patients’ care plans or medications, compared to at least seven of 10 in Norway, France, and New Zealand. Similarly, about half of U.S. physicians said they are usually notified when a patient visits an ED, compared to more than 80 percent in New Zealand and Norway.
  • Seventy-four percent of physicians in Germany and 65 percent in the U.K. said they frequently coordinated patients with social services or other community providers. In contrast, only about four of 10 in Australia, the U.S., and Canada reported the same.
  • Overall, U.S. physicians are among the most likely to offer health IT tools to better communicate with patients. However, problems of interoperability have led to challenges: just over half of U.S. providers said they could exchange patient summaries, test results, and medication lists with physicians outside their practice, compared to 80 percent or more in New Zealand, the Netherlands, and Norway.

53% Percentage of U.S. providers who said they could exchange patient summaries, test results, and medication lists with physicians outside their practice

The Big Picture

The authors point to policies in different countries that support coordination of services and effective exchange of information. For instance, Norway uses a National Health Network that provides efficient and secure electronic exchange of information between all relevant health and social service providers. The U.K. began prioritizing “social prescribing” in 2016, which allows general practitioners to refer patients to a range of nonclinical community services. For its part, the U.S. is currently testing models to connect Medicare and Medicaid beneficiaries with community services through screening, referral, and community navigation services.

The Bottom Line

Although primary care physicians in the U.S. lead other nations in several aspects of health information technology, they struggle to coordinate care and communicate with other health care providers and with social and community-based services.