U.S. Doctors Struggle to Coordinate Care with Hospitals, Social Services Providers

Primary care doctors in the U.S. struggle to coordinate care and communicate with other health and social service providers, according to results from the 2019 Commonwealth Fund International Health Policy Survey, published in December in the journal Health Affairs.

“The United States pays more for healthcare than any other country. Despite progress in using health information technologies, our primary care doctors often lack the tools to coordinate patient care and referrals with hospitals and specialists as well as with social service agencies. We must do more to strengthen primary care and improve communication across care settings,” says Michelle M. Doty, MPH, PhD., lead author of the study and Commonwealth Fund Vice President for Survey Research and Evaluation.

The survey of more than 13,000 primary care physicians in 11 high-income countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States) revealed that although the United States leads in several aspects of health information technology, its physicians still face challenges with coordinating care and exchanging information electronically outside their practice.

Related: The Top 5 Barriers to Value-Based Care

Among the main survey findings:

Primary care doctors in the United States trail their counterparts in provider-to-provider communications.
While doctors in each of the nations surveyed reported that their practices struggle to coordinate care, the U.S. primary care system falls short in these key areas:
- Communicating with specialists: At least seven in 10 physicians in Norway, France, and New Zealand receive information from specialists about changes to their patients’ medications or care plans. Only 49% do in the U.S.
- Emergency department visits: In the United States, about half of primary care doctors said they are usually notified when a patient is seen in the emergency department (ED). In New Zealand and the Netherlands, more than 80% of doctors reported usually being notified about a patient’s ED visit.
- Communication with home care: Communication with home-based nursing care is a problem across countries. Only one-third (33%) of U.S. primary care doctors said their practice routinely communicates with patients’ home care providers about patient needs and services. And just 42% of U.S. doctors said they are notified by home care providers of changes in their patients’ condition or health status.

U.S. physicians are more likely to offer health information technology to patients but struggle with interoperability.
- Patient portals and web-based tools: Overall, U.S. physicians were more likely to report offering their patients these technologies to improve communication and engagement. More than three-quarters (77%) of physicians give patients the option of communicating with them via email or a secure website. The use of other technologies, such as video consultations and remote monitoring of patients with chronic conditions, is rare in most countries, but U.S. physicians are among the most likely to use them. Physicians from Sweden and the United States lead in their use of patient portals to provide appointment scheduling, prescription refills, test results, and visit summaries.
- Interoperability and exchanging information: U.S. physicians faced challenges in exchanging information electronically with physicians outside their practice. Only about half of U.S. physicians reported being able to exchange patient clinical summaries, laboratory and diagnostic test results, and patient medication lists with outside physicians. In contrast, most physicians (72% to 93%) in the Netherlands, New Zealand, Norway, and Sweden reported these abilities.

In most countries, physicians find it challenging to coordinate with social service providers that offer housing, meals, or transportation.
Roughly four in 10 physicians in the United States (40%), Australia (38%), and Canada (42%) routinely coordinate with patients’ social service and community providers. In contrast, 74% of physicians in Germany and 65% in the U.K. frequently do so. Physicians in France (21%) and Sweden (12%) are the least likely to coordinate with social service providers. 

Asked about barriers to coordinating patient care with social services, about one-third or more of U.S. physicians said the following are major challenges: no referral system (31% in the United States; up to 45% in France); inadequate staffing (36% in the United States; up to 56% in the United Kingdom); and no follow-up from social service providers (37% in the United States; up to 61% in the United Kingdom.).

“As a physician who practiced general medicine for 35 years, I know the value of primary care and have experienced many of the challenges described in this survey. While many countries across the globe struggle to deliver all the components of good primary care, many others have developed innovative solutions,” says David Blumenthal, MD, Commonwealth Fund president. “We should learn from one another and take steps here in the United States to incentivize well-coordinated primary care. Because if it isn’t working, patients won’t get the best care possible.”