Briefing Recap: Barriers To Care For Patients With Complex Health Needs

The 2015 Commonwealth Fund International Health Policy Survey, the 18th annual, gathered information from thousands of primary care physicians in 10 Organization for Economic Cooperation and Development (OECD) countries. The results showed that while a majority of respondents feel well prepared to manage the care of patients with complex needs, their ability to provide enhanced access and care management is hindered by significant communication and coordination challenges.

The results of the study, which were published in the December 2015 issue of Health Affairs, included these major findings:

• Doctors' views of practice preparedness to manage the care of these patients decline steeply when patients have severe mental illness or substance abuse-related problems.
• Primary care practice capacity to provide enhanced access and care management depend heavily on the use of allied health professionals and technology solutions, such as email access and patient portals.
• Primary care physicians' ability to coordinate care for these patients is hampered by lack of communication with specialists, hospitals and emergency departments, home care providers, and social services organizations.
• Uptake of electronic medical records (EMRs) has been steep over the past three years, especially in Canada and the United States, but interoperability remains a significant challenge.

The authors of the paper conclude,

The need to bolster primary care in the United States is critical. Among the 10 countries in this survey, the United States has the youngest population, yet it has the highest incidence of chronic disease and spends 50-150 percent more on health care per capita than the other nine countries in the survey. This survey highlights another unwanted distinction: US primary care doctors felt among the least prepared to treat people with multiple chronic conditions and reported being among the least prepared to manage conditions associated with aging outside of hospital or nursing home settings.

Global Perspectives

Representatives from governmental health organizations in Australia, Israel, and the United States, in a discussion moderated by Health Affairs Editor-in-Chief Alan Weil, discussed and expanded upon the survey results at a media briefing at the National Press Club last Wednesday. Each speaker highlighted what he thought were the most significant findings and elaborated on conditions in his own country.

All of the speakers singled out the lack of long-term services and supports that make caring for the elderly, as well as for patients with severe mental illness and substance abuse issues, especially challenging. Richard G. Frank, Assistant Secretary for Planning and Evaluation at the US Department of Health and Human Services, said these challenges are deeply rooted. "The way we have managed long-term care historically is through separate systems, [which] results in a disconnect," he said, while citing such improvements as the program for "duals" (people eligible for both Medicare and Medicaid), and grants to states for community-based care.

Martin Bowles, Secretary of the Australian Department of Health, said that these challenges arise as an aging population coincides with the use of technology to prolong life. The Australian health care system provides health care at high quality and safety standards at a reasonable cost, he said, but noted, "Sustainability of the system is under stress." Innovations to provide more coordinated long-term care in Australia include 31 regional primary care networks and the use of health care homes. Mental health reforms include the adoption of a stepped approach that will leverage digital technology, coordinated by the primary care networks.

Although not represented in the survey results, primary care physicians in Israel feel the same frustrations as those expressed by their counterparts in other nations, said Arnon Afek, acting Associate Director General of the Israeli Ministry of Health. "We face challenges in caring for the weakened portion of our population; providers feel unable to ensure continuity of care. We must direct our quality measures at continuity," he said.

Patient-Centered Care, Health IT, And Persistent Dissatisfaction

The increasing trend toward patient-centered or patient-directed care was noted by all of the commentators. Afek pointed out that, depending on a patient's condition or preferences, the primary care physician may not be the best provider to coordinate care, giving the example of a patient with a rare digestive disorder whose closest clinical relationship was with his nutritionist. Bowles said that his country is focusing efforts on consumer-directed approaches that allow the elderly to age in place. "It's an opportunity for us to look at things differently," he said.

The survey results included information from respondents about their use of health information technology, including electronic medical records, and questioned them about their ability to receive computerized reminders for guideline-based interventions or screening tests, and to electronically exchange patient clinical summaries with doctors outside their practice. Although Israel has a national network of EMRs and a data repository based on ID numbers, Afek noted, "EMRs are only a tool, and not everyone uses them." Frank said that HIT in the US is "on the right track, but only at the first stage. It is core to our delivery system reform strategy, and represents the next frontier." Australia wants to open up digital health information to consumers via mobile technology, said Bowles.

Finally, the survey results indicated widespread frustration among primary care physicians; less than half of respondents in seven of the 10 countries reported satisfaction with the health care system. Dissatisfaction is most marked among US physicians, only 16 percent of whom agree with the statement, "On the whole, the health care system works pretty well and only minor changes are necessary to make it work better." A change in attitude among physicians may be necessary to surmount these obstacles successfully. Although described as "ready for change" and wanting to be "actively involved in the conversation" by Bowles, Afek noted that docs must "come down from Mount Olympus to address people's needs."

from Health Affairs Blog http://ift.tt/224jBiz