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Patient Experiences with Coordination of Care: The Benefit of Continuity and Primary Care Physician as Referral Source

Journal of General Internal Medicine volume 24, pages 170–177 (2009)Cite this article

ABSTRACT

BACKGROUND

Coordination across a patient’s health needs and providers is important to improving the quality of care.

OBJECTIVES

(1) Describe the extent to which adults report that their care is coordinated between their primary care physician (PCP) and specialists and (2) determine whether visit continuity with one’s PCP and the PCP as the referral source for specialist visits are associated with higher coordination ratings.

DESIGN

Cross-sectional study of the 2007 Health Tracking Household Survey.

PARTICIPANTS

A total of 3,436 adults with a PCP and one or more visits to a specialist in the past 12 months.

MEASUREMENTS

Coordination measures were patient perceptions of (1) how informed and up to date the PCP was about specialist care received, (2) whether the PCP talked with the patient about what happened at the recent specialist visit and (3) how well different doctors caring for a patient’s chronic condition work together to manage that care.

RESULTS

Less than half of respondents (46%) reported that their PCP always seemed informed about specialist care received. Visit continuity with the PCP was associated with better coordination of specialist care. For example, 62% of patients who usually see the same PCP reported that their PCP discussed with them what happened at their recent specialist visit vs. 48% of those who do not usually see the same PCP (adjusted percentages, p < 0.0001). When a patient’s recent specialist visit was based on PCP referral (vs. self-referral or some other source), 50% reported that the PCP was informed and up to date about specialist care received (vs. 35%, p < 0.0001), and 66% reported that their PCP discussed with them what happened at their recent specialist visit (vs. 47%, p < 0.0001).

CONCLUSIONS

Facilitating visit continuity between the patient and PCP, and encouraging the use of the PCP as the referral source would likely enhance care coordination.

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Acknowledgement

This study and the 2007 Health Tracking Household Survey were funded entirely by the Robert Wood Johnson Foundation. We also thank the anonymous reviewers for their feedback on an earlier version of the manuscript.

Conflict of Interest

None disclosed.

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Affiliations

  1. Center for Studying Health System Change, 600 Maryland Ave., S.W. Suite 550, Washington, DC, 20024-2512, USA

    Ann S. O’Malley MD, MPH & Peter J. Cunningham PhD

Authors
  1. Ann S. O’Malley MD, MPH
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  2. Peter J. Cunningham PhD
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Corresponding author

Correspondence to Ann S. O’Malley MD, MPH.

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O’Malley, A.S., Cunningham, P.J. Patient Experiences with Coordination of Care: The Benefit of Continuity and Primary Care Physician as Referral Source. J GEN INTERN MED 24, 170–177 (2009). https://doi.org/10.1007/s11606-008-0885-5

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  • DOI: https://doi.org/10.1007/s11606-008-0885-5

KEY WORDS

  • coordination of care
  • primary health care
  • continuity of care
  • quality of care
  • medical home
  • referral
  • patient-centered care