International Survey: U.S. Docs Lack Tools, Support

Primary care doctors in the United States are less likely than those in other industrialized countries to have the tools and support needed to provide patients with the best care possible, according to findings from the Commonwealth Fund's 2006 International Health Policy Survey.

As reported in a recent Health Affairs Web Exclusive, U.S. primary care doctors are less likely than their counterparts in Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom to be able to offer patients access to care outside regular office hours, and among the least likely to have systems in place that alert them to potentially harmful drug interactions. U.S. physicians are also less likely to receive financial incentives for improving patient care, the survey found.

For most people, the primary care doctor is their first point of contact with the health care system, as well as their main source of much preventive and essential care. Recognizing the central role of primary care physicians in health care, many industrialized countries are developing systems and policies to enhance the effectiveness and efficiency of primary care practice. These include clinical information systems, which assist doctors in treatment decisions; multidisciplinary care teams and disease management programs for patients with chronic illness; and enhanced access to care, such as after-hours appointments.

"The data show that U.S. primary care doctors find it difficult or impossible to perform tasks that doctors in other countries find easy," says Fund senior vice president Cathy Schoen, the lead author of the Health Affairs article. "They also practice without basic decision supports that could improve health outcomes and reduce costs."

Specific areas in which the U.S. trails other countries include:

• Adoption of health information technology. Only about a quarter of primary care doctors in the U.S. (28%) and Canada (23%) use electronic medical records, compared with a large majority of doctors in the Netherlands, (98%), New Zealand (92%), the U.K. (89%), and Australia (79%).
• Receipt of computerized alerts for potentially harmful drug doses or interactions. Less than a quarter of U.S. primary care doctors (23%) receive such alerts, compared with 40 percent of primary care doctors in Germany and 93 percent in the Netherlands. Among the surveyed countries, only in Canada (10%) do physicians make less use of computerized alerts than do U.S. physicians.
• Ability to offer care to patients other than during working hours. Just 40 percent of U.S. primary care doctors report they are able to offer such access, which can reduce the need for expensive emergency room care. In the Netherlands, the rate is 95 percent; in the U.K., it is 87 percent.
• Availability of financial incentives for improving quality. Just 30 percent of U.S. primary care doctors reported receiving or having the potential to receive any incentives for managing chronic disease, achieving clinical quality targets, enhancing preventive care, or any other quality improvement activities.
  

These findings are consistent with those from the Fund's 2005 international survey of patients in the same countries (excluding the Netherlands). In that earlier survey, U.S. patients were the least likely to have access to after-hours care, the most likely to use the emergency room when other care was not available, and the most likely to go without needed care because of the cost.