C A L I FOR N I A HEALTHCARE FOUNDATION s n a p s h o t Uncoordinated Care: A Survey of Physician and Patient Experience 2007
Introduction California s 36,000 primary care doctors are the point of entry for most patients needing care. In our fragmented health care system, they are often the only doctors who are responsible for the overall picture of a patient s health and health care. How well do they coordinate care and communicate with their patients? The California HealthCare Foundation asked Harris Interactive to survey the state s primary care physicians for a check-up on how they view their relationship with their patients. Four of every ten physicians report that their patients have had problems with coordination of their care in the last 12 months. More than 60 percent of doctors report that their patients sometimes or often experience long wait times for diagnostic tests. Some 20 percent of doctors report having their patients repeat tests because of an inability to locate the results during a scheduled visit. In spite of reporting difficulties coordinating care, physicians rarely use email to communicate with other providers. The report finds that solo practitioners are better at some things, like coordination of care, but lag in others, like electronic access to test results and notifications of potentially dangerous drug interactions, while large health care systems like Permanente perform better. 2007 California HealthCare Foundation
Patient Problems with Coordination of Care Across Providers and Sites, 2007 3% Often 6% PRACTICE TYPE OF SOMETIMES AND OFTEN SUBSETS 24% 6% 35% 5% 37% 9% 39% About 40 percent of California physicians reported that over the past 12 months their patients experienced problems because care was not well coordinated across multiple sites or providers. Rarely/Never 58% Sometimes 33% practices were least likely to report that their patients experienced problems with coordination. 2007 California HealthCare Foundation
Frequency of Long Wait Times for Patients Needing Diagnostic Tests, 2007 1% Rarely/Never 38% Often 13% PRACTICE TYPE OF OFTEN SUBSET 5% 11% 13% 15% Thirteen percent of California physicians report their patients often experience long waiting times for diagnostic tests. Long waiting times are less frequent within s fully integrated system. Sometimes 48% 2007 California HealthCare Foundation
Electronic Access to Diagnostic Test Results, 2007 2% PRACTICE TYPE OF ROUTINELY SUBSET 19% 38% 69% 95% Electronic access to diagnostic test information allows results to be viewed earlier, decreases the ordering of unnecessary tests, and enables more timely intervention. No 30% Occasionally 17% Routinely 51% Over half of the physicians surveyed reported they routinely access test results electronically. The larger the group, the more likely that the physicians access test results electronically. 2007 California HealthCare Foundation
Frequency of Repeated Tests or Procedures, 2007 3% Often 3% Sometimes 18% PRACTICE TYPE OF SOMETIMES AND OFTEN SUBSETS 12% 2% 18% 1% 19% 5% 19% 7% Over the past 12 months, 21 percent of physicians in California reported that their patients sometimes or often had tests repeated because the findings were not available at the time of the patient s scheduled visit. Rarely/Never 76% 2007 California HealthCare Foundation
Patients Receiving Untimely or Inappropriate Follow-up on Positive Test Results, 2007 3% Often 2% Sometimes 18% PRACTICE TYPE OF SOMETIMES AND OFTEN SUBSETS 18% 3% 16% 1% 19% 26% 2% Twenty percent of California physicians reported that their patients may not have received timely or appropriate follow-up on positive test results, which can lead to complications and delays in treatment. Rarely/Never 77% 2007 California HealthCare Foundation
Receipt of Patient Test Result Alerts, 2007 Almost 60 percent of PRACTICE TYPE OF YES, USING A COMPUTERIZED SYSTEM SUBSET California s physicians receive an alert to 3% No 39% Yes, using computerized system 24% 10% 9% 33% 62% provide patients with test results. However, less than 25 percent of these are received using a computerized system. s physicians receive automated alerts or prompts almost twice Yes, using manual system 34% as often as do physicians at other large practices. 2007 California HealthCare Foundation
Physician Receipt of Drug Dose/Interaction Alert, 2007 2% No 43% Yes, using computerized system 30% PRACTICE TYPE OF YES, USING A COMPUTERIZED SYSTEM SUBSET 9% 22% 38% 73% Over 40 percent of California s physicians do not have a process in place to receive notification about a potential drug dose or interaction. Physicians belonging large practices are more likely to receive the prompt electronically. Yes, using manual system 25% 2007 California HealthCare Foundation
Adverse Drug Events, 2007 Received Wrong Drug/Dose or Preventable Drug Interaction 4% Often 1% Sometimes 5% 6% Documented Process for Adverse Events Six percent of California physicians reported that their patients may have received the wrong drug, wrong dose, or had a preventable drug interaction. Rarely/Never 90% No 31% Yes, for Adverse Drug Reactions Only 18% Yes, for All Adverse Events 45% Thirty-one percent of physicians do not have a documented process for follow-up and analysis of adverse events, including drug reactions. 2007 California HealthCare Foundation 10
Patient Medication List Compilation, 2007 Very Difficult/ Cannot Generate 33% Easy 41% Somewhat Difficult 24% PRACTICE TYPE OF VERY AND SOMEWHAT DIFFICULT SUBSETS 2% 30% 33% 29% 45% 27% 36% 15% 3% Fifty-seven percent of physicians reported that it was difficult to compile a comprehensive list of their patient s medications, including those from other doctors, using their current patient medical records system. physicians have less difficulty generating a list of medications than physicians in other practices. 2007 California HealthCare Foundation 11
Patients Experiencing Long Wait Times for Specialists, 2007 1% PRACTICE TYPE OF OFTEN SUBSET 32% 35% 36% Almost one-third of California physicians say their patients often experience long wait times for specialist/ consultant visits. 13% Rarely/Never 21% Often 30% Sometimes 48% 2007 California HealthCare Foundation 12
Physicians Receiving Patient Referral Results, 2007 3% PRACTICE TYPE OF UP TO HALF SUBSET 37% 38% 41% 42% Forty-one percent of California physicians reported problems with receipt of referral results. For these physicians, results were missing up to half of the time. Almost All 25% Up to Half 41% Most 31% 2007 California HealthCare Foundation 13
Patient Records/Clinical Information Unavailable at Time of Visit, 2007 3% Rarely/Never 54% Often 11% Sometimes 32% PRACTICE TYPE OF SOMETIMES AND OFTEN SUBSETS 16% 4% 36% 11% 40% 16% 37% 12% Over 40 percent of California physicians reported that their patient s medical record or other relevant clinical information may not have been available at the time of a scheduled visit. practices are least likely to report that their patients have had a negative experience due to a lack of coordination of information in their office. 2007 California HealthCare Foundation 14
Email Communication with Other Physicians, by Practice Type, 2007 In spite of reporting difficulties with 6% 16% 10% 25% 13% 34% 59% Often Sometimes Rarely coordination of care, physicians rarely use email to communicate with other physicians. 77% This is particularly true in 64% small and solo practices. 51% 34% 5% 2007 California HealthCare Foundation 15
Physician Satisfaction with Time Spent per Patient, 2007 2% Very Satisfied 18% Somewhat Satisfied 40% Somewhat/Very Dissatisfied 40% PRACTICE TYPE OF DISSATISFIED SUBSET Sources: Harris Interactive, Health Perspectives in California, June 2007. The Commonwealth Fund, Diagnostic Scope of Exposure to Primary Care Physicians in Australia, New Zealand, and the U.S., June 2007. 33% 35% 47% 52% Forty percent of California physicians wish they could spend more time with their patients. practices, including, were more likely to report dissatisfaction with the amount of time spent per patient. The average American spends about 30 minutes per year with a primary care physician. The U.S. Prevention Services Task Force recommends an average of 37 minutes a year for children and 40 minutes for adults. 2007 California HealthCare Foundation 16
Office Hours Available to Patients, 2007 100% 80% Over two-thirds of California physicians report that they offer either early morning, evening, or weekend appointments. 60% 67% 40% 47% 39% 33% 20% 0% Some early morning hours (before 8:30 am) Some evening hours (after 6 pm) Some weekend hours Some of any of these 2007 California HealthCare Foundation 17
Preventable ED Visits*, 2006 All Other Recent ED Users 79% n=1,000 Preventable ED Users 21% PREVENTABLE ED USERS PREFERRING A VISIT TO A PRIMARY CARE PHYSICIAN *ED (emergency department) users are those whose last visit to the ED either (a) occurred during weekday business hours and was for a problem that could have been treated by a PCP or; (b) was for a problem that could have waited longer than 24 hours to treat. Source: Harris Interactive, Exploring ED Use in California, July 2006. 39% In California, the lack of access to a PCP is the number one reason patients go to the emergency department, according to primary care and emergency physicians. Of the 21 percent of patients whose visits could have been prevented, almost 40 percent said they would have gone to a PCP instead of the ED if they could have gotten an appointment within 1 to 3 days. 2007 California HealthCare Foundation 18
Same Day Appointment Availability, 2007 1% Primary Care Physicians About Half or Fewer 27% Most (60 80%) 26% Almost All (> 80%) 46% Total CA 45% Recent ED Visitors Preventable ED User Consumers 35% 38% In a recent survey, 46 percent of primary care physicians reported that their patients were able to get a same day appointment. However, 38 percent of recent ED visitors reported they were able to get a same day appointment the last time they needed medical attention. Source: Harris Interactive, Exploring ED Use in California, July 2006. 2007 California HealthCare Foundation 19
Patient Desire for Email Communication with Physicians, 2007 Use It Now Would Like to Have It Email to communicate directly with my doctor 4% 74% Ability to schedule a doctor s visit via the Internet 3% 75% Receive the results of diagnostic tests via email 2% 67% A home monitoring device that allows me to send medical information like blood pressure readings or blood tests to the doctor s office via the telephone or email Reminders via email from my doctors when you are due for a visit or some type of medical care 2% 57% 4% 77% A survey of online adults indicates that the overwhelming majority would like to communicate directly with their physician via email, to receive the results of diagnostic tests via email, and to receive email reminders for visits or other medical care issues. Source: Harris Interactive, The Benefits of Electronic Medical Records Sound Good, but Privacy Could Become a Difficult Issue, February 2007. 2007 California HealthCare Foundation 20
Email Communication with Patients, by Practice Type, 2007 Online communication 5% 13% 83% 15% 81% 2% 5% 7% 88% 24% 32% Often Sometimes Rarely between physicians and patients has been identified as one of a limited number of information technologies targeted for rapid development by the American Health Information 41% Community.* However, few physicians use email to communicate with patients regarding treatment. (n=114) (n=147) (n=106) Sources: Harris Interactive, Health Perspectives in California, June 2007 and The Benefits of Electronic Medical Records Sound Good, but Privacy Could Become a Difficult Issue, February 2007. * The American Health Information Community is a federal advisory board that makes recommendations on the development and adoption of health information technology to the U.S. Department of Health and Human Services. 2007 California HealthCare Foundation 21
Conclusions Clearly there is room for improvement in the interactions that primary care physicians have with other providers and their patients. Though technology can help and larger medical groups have an advantage in the adoption of health information tools it is not the final answer. Even physicians with access to medical record systems still report problems with developing comprehensive medication lists for their patients, problems with patient records sometimes being unavailable at the time of a patient visit, and delays receiving and retrieving patient referral results. As frustrated as physicians may be with these information gaps, patients bear the brunt of the problem. Repeated tests and procedures, long waits to receive results from diagnostic tests, and inadequate follow-up have a negative impact on patients. Improving communication channels, perhaps even expanding the use of modern mechanisms such as email, can go along away toward improving the quality and patient-centeredness of health care delivery. 2007 California HealthCare Foundation 22
Sources The Commonwealth Fund, Diagnostic Scope of Exposure to Primary Care Physicians in Australia, New Zealand, and the U.S., June 2007. The Commonwealth Fund, Physician s View on Quality of Care: Findings from The Commonwealth Fund National Survey of Physicians and Quality of Care, May 2005. Harris Interactive, The Benefits of Electronic Medical Records Sounds Good but Privacy Could Become a Difficult Issue, February 2007. Harris Interactive, Exploring ED Use in California, June 2006. Harris Interactive, Health Perspectives in California, June 2007. The National Academy of Sciences, Crossing the Quality Chasm: A New Health System for the 21st Century, 2000. Methodology This chart pack includes key findings from Harris Interactive survey. The survey was conducted by mail with 361 interviews obtained between February 26 and May 23, 2007. The survey data was weighted by gender, years in practice, office or hospital setting, and specialty to represent the statewide population of physicians in California. Sixtyone of the respondents did not provide information on their practice size and therefore were excluded from practice size analyses. The sample was drawn for the current AMA master file of all medical doctors practicing in California. Acknowledgment The instrument used in the survey of primary care physicians was based on one developed by The Commonwealth Fund for their international survey of physicians. The California HealthCare Foundation is grateful for the generosity of The Commonwealth Fund in allowing use of the survey and for advice in the development of this variation. Give Us Your Feedback Was the information provided in this report of value? Are there additional kinds of information or data you would like to see included in future reports of this type? Is there other research in this subject area you would like to see? We would like to know. Please click here to access our feedback form. Or visit www.chcf.org/feedback and enter Report Code #1195. Thank you. for more information C A L I FOR N I A HEALTHCARE FOUNDATION California HealthCare Foundation 1438 Webster Street Suite 400 Oakland, CA 94612 510.238.1040 www.chcf.org 2007 California HealthCare Foundation 23