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Ron D, Gunn CM, Havidich JE, Ballacchino MM, Burdick TE, Deiner SG. Preoperative Communication Between Anesthesia, Surgery, and Primary Care Providers for Older Surgical Patients. Jt Comm J Qual Patient Saf 2024; 50:326-337. [PMID: 38360446 DOI: 10.1016/j.jcjq.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Suboptimal communication between clinicians remains a frequent driver of preventable adverse health care-related events, increased costs, and patient and physician dissatisfaction. METHODS Cross-sectional surveys on preoperative interspecialty communication, tailored by stakeholder type, were administered to (1) primary care providers in northern New England, (2) anesthesia providers working in the perioperative clinic of a tertiary rural academic medical center, (3) surgeons from the same center, and (4) older surgical patients who underwent preoperative assessment at the same center. RESULTS In total, 107/249 (43.0%) providers and 103/265 (39.9%) patients completed the survey. Preoperative communication was perceived as logistically challenging (59.8%), particularly across health systems. More than 77% of anesthesia and surgery providers indicated that they communicate frequently or sometimes, but 92.5% of primary care providers indicated that they rarely or never communicate with anesthesia providers. Some of the most common reasons for preoperative communication were discussion of complex patients, perioperative medication management, and optimization of comorbidities. Although 96.1% of older surgical patients reported that preoperative communication between providers is important, only 40.4% felt that their providers communicate very or extremely well. Many patients emphasized the importance of preoperative communication between providers to ensure transfer of critical clinical information. CONCLUSION Surgeons and anesthesiologists infrequently communicate with primary care providers in one rural tertiary center, in contrast to patient expectations and values. These study results will help identify priorities and potentially resolvable barriers to bridging the gap between the inpatient perioperative and outpatient primary care teams. Future studies should focus on strategies to improve communication between hospital and community providers to prevent complications and readmission.
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Okamura N, Kubo E, Ishida A, Noda S, Harada M, Ishizuka K, Inoue Y, Kosugi K, Miura T. Differences in discharge letter content: oncologists' vs. home care physicians' needs. Support Care Cancer 2024; 32:299. [PMID: 38644420 DOI: 10.1007/s00520-024-08507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 04/15/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE To compare the details, oncologists include in discharge letters with what home care physicians need. Although discharge letters are important to share patients' information for home palliative care, few studies have compared the details, especially patients' emotions, regarding what oncologists include in discharge letters and home care physicians' needs. METHODS This cross-sectional study was conducted by sending anonymous, self-administered questionnaires to 500 certified oncologists (OCs) and 500 directors of home care supporting clinics (HCs) in Japan between March and May 2023. The survey considered 20 potential items found in discharge letters, and compared rates of OCs including these items and HCs needs. RESULTS Of 310 valid responses, 186 were from OCs (average age: 47.7; 29 females) and 124 from HCs (average age: 55.4; 9 females). Major items with lower inclusion rates for OCs included patients' emotions regarding medical conditions (58.4% in OCs vs. 92.6% in HCs, p < 0.001), families' emotions regarding medical conditions (60.0 vs. 92.6%, respectively, p < 0.001), patients' perceptions regarding medical conditions (84.9 vs. 94.3%, respectively, p = 0.011), families' perceptions regarding medical conditions (84.3 vs. 95.1%, respectively, p = 0.004), and potential late-onset treatment-related adverse events (79.3 vs. 92.6%, respectively, p = 0.002). Conversely, OCs included patients' activities of daily living more frequently (96.2 vs. 90.2%, respectively, p = 0.031). CONCLUSION Transitioning to home-based palliative care may necessitate accurate information and consideration of patients' and families' perceptions and emotions regarding medical conditions in discharge letters for continuous provision of high-quality care.
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Affiliation(s)
- Nozomi Okamura
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
- Department of Nephrology, Aso Iizuka Hospital, Iizuka, Japan
| | - Emi Kubo
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Ayaka Ishida
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Sakiho Noda
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Mariko Harada
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Keisuke Ishizuka
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Yujiro Inoue
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Kazuhiro Kosugi
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan.
- Division of Biomarker Discovery, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Kashiwa, Japan.
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McCormack C, Savoy A, Mathew A, Gilmore AM, Cottingham E, Sangani A, Caldwell B, Holden RJ, Weiner M. Characterizing barriers to closing cross-institutional referral loops: Workflow and information flow analysis. APPLIED ERGONOMICS 2024; 115:104177. [PMID: 38016271 PMCID: PMC10863302 DOI: 10.1016/j.apergo.2023.104177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/28/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
The specialty referral process consists of primary care clinicians referring patients to specialty consultants. This care transition requires effective care coordination and health information exchange between care teams; however, breakdowns in workflow and information flow impede "closing the referral loop" and delay or prevent referrers from receiving the consultant's "visit notes," particularly in cross-institutional referrals. This study aimed to describe and map the referral process as it occurs in clinics and identify and characterize work system barriers affecting its performance. Referrers and consultants were interviewed about their perceived workflows, barriers, and clinical outcomes to inform a workflow analysis.
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Affiliation(s)
| | - April Savoy
- Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indiana, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
| | - Anna Mathew
- Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indiana, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA
| | | | | | - Amee Sangani
- Regenstrief Institute, Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Barrett Caldwell
- Purdue University School of Industrial Engineering, West Lafayette, IN, USA
| | - Richard J Holden
- Regenstrief Institute, Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Michael Weiner
- Regenstrief Institute, Inc., Indianapolis, IN, USA; Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
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4
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Hauzer M, Grimberg R, Samuels N, Keshet Y, Mordechai A, Dagash J, Ben-Arye E. Exploring primary care physician feedback following an integrative oncology consultation. Support Care Cancer 2023; 31:606. [PMID: 37787815 DOI: 10.1007/s00520-023-08079-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE To explore responses from primary care physicians (PCPs) from an integrative physician (IP) consultation and recommended integrative oncology (IO) treatment program. METHODS Chemotherapy-treated patients were referred by their oncology healthcare professional to an IP, a physician dually trained in complementary medicine and supportive cancer care. The consultation summary and patient-centered IO treatment program was then sent to the patient's PCP, with PCP-to-IP responses analyzed qualitatively using ATLAS.Ti software for systematic coding and content analysis. Trial Registration Number NCT01860365 published May 22, 2013. RESULTS Of the 597 IP consultations conducted, 470 (78.7%) summaries were sent to patients' PCPs, with only 69 (14.7%) PCP-to-IP responses returned. PCPs were more likely to respond if the patient was Hebrew-speaking (78.3% vs. 65.1%, P = 0.032). Systematic coding identified four predominant themes among PCP narratives: addressing the patient's medical condition and leading QoL-related concerns; patient-centered reflections; available resources providing support and promoting resilience; and PCP attitudes to the IO treatment program. CONCLUSION PCP-IP communication can provide valuable insight into the patient's bio-psycho-social care, addressing the patient's health-belief model, emotional concerns, caregiver-related factors, preferences, and barriers to adherence to IO care. PRACTICE IMPLICATIONS Healthcare services should consider promoting IP-PCP communication in order to facilitate better patient outcomes from an IO treatment program.
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Affiliation(s)
- Michael Hauzer
- Department of Family Medicine, Haifa & Western Galilee District, Clalit Health Services Community Division, HaShahaf 6, Bat-Galim, Haifa, Israel.
- Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Ran Grimberg
- Department of Family Medicine, Haifa & Western Galilee District, Clalit Health Services Community Division, HaShahaf 6, Bat-Galim, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Keshet
- Department of Sociology, Western Galilee Academic College, Galilee, Israel
| | - Alperin Mordechai
- Department of Family Medicine, Haifa & Western Galilee District, Clalit Health Services Community Division, HaShahaf 6, Bat-Galim, Haifa, Israel
| | - Jamal Dagash
- Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Palliative Care-Home Care Hospice, Clalit Health Services, Haifa and Western Galilee District, Jerusalem, Israel
| | - Eran Ben-Arye
- Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Integrative Oncology Program, The Oncology Service, Lin Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel
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Use of modern information communication technology to enable real-time consultation between primary and specialty care providers. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:966-967.e1. [PMID: 36410661 DOI: 10.1016/j.jaip.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022]
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Johner N, Gencer B. Improving atrial fibrillation outcomes through interclinician electronic consultation. Eur J Clin Invest 2023; 53:e13933. [PMID: 36477800 DOI: 10.1111/eci.13933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Nicolas Johner
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
| | - Baris Gencer
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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7
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Timmins L, Kern LM, O'Malley AS, Urato C, Ghosh A, Rich E. Communication Gaps Persist Between Primary Care and Specialist Physicians. Ann Fam Med 2022; 20:343-347. [PMID: 35879085 PMCID: PMC9328695 DOI: 10.1370/afm.2781] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/15/2021] [Accepted: 09/28/2021] [Indexed: 11/09/2022] Open
Abstract
A survey conducted with data from 2008 found that physicians often do not communicate with each other at the time of referral or after consultation. Communication between physicians might have improved since then, with the dissemination of electronic health records (EHRs), but this is not known. We used 2019 survey data to measure primary care physicians' perceptions of communication at the time of referral and after consultation. We found that large gaps in communication persist. The similarity between these survey results suggests that despite the dissemination of EHRs, physicians still do not consistently communicate with each other about the patients they share.
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Iqbal N, Huynh C, Maidment I. Systematic literature review of pharmacists in general practice in supporting the implementation of shared care agreements in primary care. Syst Rev 2022; 11:88. [PMID: 35546411 PMCID: PMC9091138 DOI: 10.1186/s13643-022-01933-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rising demand for healthcare continues to impact all sectors of the health service. As a result of the growing ageing population and the burden of chronic disease, healthcare has become more complex, and the need for more efficient management of specialist medication across the healthcare interface is of paramount importance. With the rising number of pharmacists working in primary care in clinical roles, is this a role that pharmacists could support to ensure the successful execution of shared care agreement (SCA) in primary care for these patients? AIM OF THE REVIEW Systematic review to identify activities and assess the interventions provided by pharmacists in primary care on SCA provision and how it affects health-related quality of life (HRQoL) for patients. METHOD Primary studies in English which tested the intervention or obtained views of stakeholders related to pharmacist input to shared care agreement within primary care were included. The following electronic databases were systematically searched from the date of inception to November 2021: AMED®, CINAHL®, Cochrane Database of Systematic Reviews (CDSR), EMBASE®, EMCARE®, Google Scholar, HMIC®, MEDLINE®, PsycINFO®, Scopus and Web of Science®. Grey literature sources were also searched. The search was adapted according to the respective database-specific search tools. It was searched using a combination of Medical Subject Heading terms (MeSH), free-text search terms and Boolean operators. RESULTS A total of 5244 titles/abstracts were screened after duplicates were removed, and 64 full articles were assessed for eligibility. On examination of full text, no studies met the inclusion criteria for this review. CONCLUSION This review highlights the need for further research to evaluate how pharmacists in general practice can support the safe and effective integration of specialist medication in primary care with the use of SCA. SYSTEMATIC REVIEW REGISTRATION NIHR PROSPERO No: 2020 CRD42020165363 .
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Affiliation(s)
- Naveed Iqbal
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK.
| | - Chi Huynh
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK
| | - Ian Maidment
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK
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9
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House S, Wilmoth M, Stucky C. Relational coordination as a merger and acquisition framework for healthcare organizations. Nurs Manag (Harrow) 2022; 53:36-42. [PMID: 35105844 DOI: 10.1097/01.numa.0000816256.13974.1b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Sherita House
- Sherita House is a postdoctoral fellow at Indiana University School of Nursing in Indianapolis, Ind. Margaret Wilmoth is the executive vice dean of academic affairs at the University of North Carolina at Chapel Hill School of Nursing in Chapel Hill, N.C. Christopher Stucky is the deputy chief of the Center for Nursing Science and Clinical Inquiry at Landstuhl Regional Medical Center in Landstuhl, Germany
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10
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Nunnally ME, Ferrer R, Martin GS, Martin-Loeches I, Machado FR, De Backer D, Coopersmith CM, Deutschman CS. The Surviving Sepsis Campaign: research priorities for the administration, epidemiology, scoring and identification of sepsis. Intensive Care Med Exp 2021; 9:34. [PMID: 34212256 PMCID: PMC8249046 DOI: 10.1186/s40635-021-00400-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/07/2021] [Indexed: 12/15/2022] Open
Abstract
Objective To identify priorities for administrative, epidemiologic and diagnostic research in sepsis. Design As a follow-up to a previous consensus statement about sepsis research, members of the Surviving Sepsis Campaign Research Committee, representing the European Society of Intensive Care Medicine and the Society of Critical Care Medicine addressed six questions regarding care delivery, epidemiology, organ dysfunction, screening, identification of septic shock, and information that can predict outcomes in sepsis. Methods Six questions from the Scoring/Identification and Administration sections of the original Research Priorities publication were explored in greater detail to better examine the knowledge gaps and rationales for questions that were previously identified through a consensus process. Results The document provides a framework for priorities in research to address the following questions: (1) What is the optimal model of delivering sepsis care?; (2) What is the epidemiology of sepsis susceptibility and response to treatment?; (3) What information identifies organ dysfunction?; (4) How can we screen for sepsis in various settings?; (5) How do we identify septic shock?; and (6) What in-hospital clinical information is associated with important outcomes in patients with sepsis? Conclusions There is substantial knowledge of sepsis epidemiology and ways to identify and treat sepsis patients, but many gaps remain. Areas of uncertainty identified in this manuscript can help prioritize initiatives to improve an understanding of individual patient and demographic heterogeneity with sepsis and septic shock, biomarkers and accurate patient identification, organ dysfunction, and ways to improve sepsis care.
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Affiliation(s)
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Shock, Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Greg S Martin
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Grady Memorial Hospital and Emory Critical Care Center, Emory University, Atlanta, GA, USA
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), Department of Intensive Care Medicine, St. James's University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland.,Hospital Clinic, IDIBAPS, Universidad de Barcelona, CIBERes, Barcelona, Spain
| | | | - Daniel De Backer
- Chirec Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Craig M Coopersmith
- Department of Surgery and Emory Critical Care Center, Emory University, Atlanta, GA, USA
| | - Clifford S Deutschman
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA.,The Feinstein Institute for Medical Research/ Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
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Vargas I, Eguiguren P, Mogollón-Pérez AS, Samico I, Bertolotto F, López-Vázquez J, Vázquez ML. Can care coordination across levels be improved through the implementation of participatory action research interventions? Outcomes and conditions for sustaining changes in five Latin American countries. BMC Health Serv Res 2020; 20:941. [PMID: 33046079 PMCID: PMC7552474 DOI: 10.1186/s12913-020-05781-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Finding new strategies for care integration has become a policy priority for many fragmented health systems in Latin America. Although the implementation of interventions through a participatory action research (PAR) approach is considered to be more effective in achieving organizational change, its application is scarce. This study, part of the research project Equity-LA II, aims to analyze the impact of PAR interventions on care coordination across levels, and key aspects for their sustainability and transferability, from the stakeholder viewpoint in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay. Different interventions were designed and implemented through a PAR process to improve communication and clinical agreement between primary care and secondary care doctors: joint meetings to discuss clinical cases and/or training; shared care guidelines; offline virtual consultations; a referral and reply letter; and an induction program. METHODS A qualitative, descriptive-interpretative study was conducted in the healthcare network of each country. Focus groups and semi-structured individual interviews were conducted with a criterion sample of participants: local steering committee (29) and professional platform members (28), other health professionals (49) and managers (28). Thematic content analysis was conducted, segmented by country and type of intervention. RESULTS Informants highlighted that joint meetings based on reflexive methods contributed substantially to improving contextually relevant elements of clinical management coordination - communication in patient follow-up, clinical agreement, appropriateness of referrals - and also administrative coordination. The meetings, alongside the PAR process, also helped to improve interaction between professionals - knowing each other personally and mutual trust - thus fostering willingness to collaborate. The PAR approach, moreover, served to spread awareness of the coordination problems and need for intervention, encouraging greater commitment and interest in participating. No noteworthy contributions were identified in remaining interventions due to low uptake. A necessary condition for the sustainability and replicability was that PAR process had to be used appropriately in a favourable context. CONCLUSIONS Evidence is provided on the substantial contribution of interventions to improving locally relevant clinical coordination elements and professional interaction when implemented through an adequate PAR process (in terms of time, method and participation levels), a necessary condition for their sustainability and replicability.
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Affiliation(s)
- Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo 21, 08022, Barcelona, Spain.
| | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Facultad de Medicina, Universidad de Chile, Avenida Independencia, 939, Santiago de Chile, Chile
| | - Amparo-Susana Mogollón-Pérez
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cra 24 No. 63C-69, Quinta Mutis, 11001, Bogotá, Colombia
| | - Isabella Samico
- Grupo de Estudos de Gestão e Avaliação em Saúde, Instituto de Medicina Integral Prof. Fernando Figueira, Rua Dos Coelhos No. 300, Boa Vista, 50070-550 Recife, Brazil
| | - Fernando Bertolotto
- Facultad de Enfermería, Universidad de la República, Avenida 18 de Julio 124, 11200, Montevideo, Uruguay
| | - Julieta López-Vázquez
- Instituto de Salud Pública, Universidad Veracruzana, Avenida Dr. Luis Castelazo Ayala s/n. Col. Industrial Ánimas, 91190 Xalapa, Veracruz, Mexico
| | - María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo 21, 08022, Barcelona, Spain
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Kumar K, Mak V, Groom K, Razak Y, Brown JL, Hyde T, Bokobza A, Coker RK, Parmar M, Wong E, Han LY, Elkin SL. Respiratory specialists working in different ways: Development of a GP hotline and respiratory support service during the COVID-19 pandemic. Future Healthc J 2020; 7:e88-e92. [PMID: 33094266 DOI: 10.7861/fhj.2020-0082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Integration of primary and secondary care for the management of respiratory disease is a long-held ambition. Here, we describe how respiratory specialists at a large NHS trust, working with primary care clinicians in the area, set up a GP hotline and respiratory support service in response to the COVID-19 pandemic, with the aim of enhancing delivery of care to patients in this unprecedented time. Working across traditional organisational boundaries in this way confers benefits to patients and clinicians, illustrating the value of new, integrated models of care.
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Affiliation(s)
- Kartik Kumar
- Imperial College Healthcare NHS Trust, London, UK and NIHR Imperial BRC clinical research fellow in respiratory medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Vincent Mak
- Imperial College Healthcare NHS Trust, London, UK and clinical director of the London Respiratory Strategic Clinical Network
| | | | | | | | - Toby Hyde
- Imperial College Healthcare NHS Trust, London, UK
| | - Anna Bokobza
- Imperial College Healthcare NHS Trust, London, UK
| | - Robina K Coker
- Imperial College Healthcare NHS Trust, London, UK and honorary clinical senior lecturer, National Heart and Lung Institute, Imperial College London, London, UK
| | - Mohini Parmar
- Barnabas Medical Centre, London, UK and chair, NHS Ealing Clinical Commissioning Group
| | - Ernie Wong
- Imperial College Healthcare NHS Trust, London, UK and honorary clinical senior lecturer, National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Sarah L Elkin
- Imperial College Healthcare NHS Trust, London, UK, and honorary clinical senior lecturer, National Heart and Lung Institute, Imperial College London, London, UK
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Slavin MJ, Rajan M, Kern LM. Internal medicine residents identify gaps in medical education on outpatient referrals. BMC MEDICAL EDUCATION 2020; 20:243. [PMID: 32731856 PMCID: PMC7392837 DOI: 10.1186/s12909-020-02177-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Relevant clinical information is often missing when a patient sees a specialist after being referred by another physician in the ambulatory setting. This can result in missed or delayed diagnoses, delayed treatment, unnecessary testing, and drug interactions. Residents' attitudes toward providing clinical information at the time of referral and their perspectives toward training on referral skills are not clear. We sought to assess internal medicine residents' attitudes toward and experiences with outpatient referrals. METHODS We conducted a cross-sectional survey in October-December 2018 of all internal medicine interns and residents affiliated with a large, urban internal medicine residency program in New York, NY. We used a novel survey instrument that included 13 questions about attitudes toward and experiences with outpatient referrals. We used descriptive statistics to characterize the results. RESULTS Overall, 122 of 132 residents participated (92% response rate). Respondents were approximately equally distributed across post-graduate years 1-3. Although 83% of residents reported that it is "always" important to provide the clinical reason for a referral, only 11% stated that they "always" provide a sufficient amount of clinical information for the consulting provider when making a referral. Only 9% of residents "strongly agree" that residency provides sufficient training in knowing when to refer patients, and only 8% "strongly agree" that residency provides sufficient training in what information to provide the consulting physician. CONCLUSIONS These results suggest a substantial discrepancy between the amount of information residents believe they should provide at the time of a referral and the amount they actually provide. Many residents report not receiving adequate training during residency on when to refer patients and what clinical information to provide at the time of referral. Improvements to medical education regarding outpatient referrals are urgently needed.
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Affiliation(s)
| | | | - Lisa M Kern
- Weill Cornell Medicine, New York, NY, 10021, USA.
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14
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Michaelsen JJ. The 'difficult patient' phenomenon in home nursing and 'self-inflicted' illness. Scand J Caring Sci 2020; 35:761-768. [PMID: 32666524 DOI: 10.1111/scs.12890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 11/30/2022]
Abstract
RATIONALE AND AIM Home nurses work largely alone, and consequently, 'difficult patients' can be challenging for them. Understanding of this phenomenon can have a major impact on the quality of care. The aim is to explore how nurses characterise, relate to and interact with these patients. Why do nurses perceive some patients as difficult and what are the consequences for the patient? What are these patients´ expectations of the nurses and their perceptions of illness? METHODS An ethnographic study with 30 participant observations of 12 nurses visiting 146 patients was conducted. A total of 6 interviews were made with 4 'difficult patients' and 11 interviews with 5 nurses. FINDINGS In the nurses' view, the 'difficult patients' had little insight into their illnesses, denied they were ill and were noncompliant. Some nurses had negative feelings about a patient, regarded the patient as too demanding or found the patient´s personal characteristics repulsive. The difficulty lies in the relationship between nurse and patient. Important health problems of some patients remained unrecognised. The nurses regarded the patients' illnesses as self-inflicted. The patients had low expectations of nurses, lacked knowledge about what to expect of them, and their views on their illnesses differed from those of the nurses. Contributing causes of patients becoming difficult for nurses seemed to be different norms and values and the nurses' work situation. CONCLUSION It is important that nurses communicate their knowledge about the connection between illness and pathogenic social conditions and discuss 'self-inflicted' illness and their role in relation to this. Supervision is suggested. Improved working conditions could lead to fewer 'difficult patients'. STUDY LIMITATIONS The perspectives of patients should be studied in greater detail.
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Affiliation(s)
- Jette Joost Michaelsen
- Department of Public Health, Section of Health Services Research, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, DK-1014, Denmark
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15
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Scaioli G, Schäfer WLA, Boerma WGW, Spreeuwenberg PMM, Schellevis FG, Groenewegen PP. Communication between general practitioners and medical specialists in the referral process: a cross-sectional survey in 34 countries. BMC FAMILY PRACTICE 2020; 21:54. [PMID: 32183771 PMCID: PMC7079351 DOI: 10.1186/s12875-020-01124-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/09/2020] [Indexed: 11/29/2022]
Abstract
Background The communication of relevant patient information between general practitioners (GPs) and medical specialists is important in order to avoid fragmentation of care thus achieving a higher quality of care and ensuring physicians’ and patients’ satisfaction. However, this communication is often not carried out properly. The objective of this study is to assess whether communication between GPs and medical specialists in the referral process is associated with the organisation of primary care within a country, the characteristics of the GPs, and the characteristics of the primary care practices themselves. Methods An analysis of a cross-sectional survey among GPs in 34 countries was conducted. The odds ratios of the features that were expected to relate to higher rates of referral letters sent and communications fed back to GPs were calculated using ordered logistic multilevel models. Results A total of 7183 GPs from 34 countries were surveyed. Variations between countries in referral letters sent and feedback communication received did occur. Little of the variance between countries could be explained. GPs stated that they send more referral letters, and receive more feedback communications from medical specialists, in countries where they act as gatekeepers, and when, in general, they interact more with specialists. GPs reported higher use of referral letters when they had a secretary and/or a nurse in their practice, used health information technologies, and had greater job satisfaction. Conclusions There are large differences in communication between GPs and medical specialists. These differences can partly be explained by characteristics of the country, the GP and the primary care practice. Further studies should also take the organisation of secondary care into account.
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Affiliation(s)
- Giacomo Scaioli
- Department of Public Health Sciences, University of Turin, Piazza Polonia, 94, 10126, Torino, Italy
| | - Willemijn L A Schäfer
- Department of Surgery, Northwestern University, Feinberg School of Medicine, 633 N. St Clair Street, Chicago, IL, 60611, USA
| | - Wienke G W Boerma
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, Utrecht, 3500BN, The Netherlands
| | - Peter M M Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, Utrecht, 3500BN, The Netherlands
| | - François G Schellevis
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, Utrecht, 3500BN, The Netherlands.,Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT, the Netherlands
| | - Peter P Groenewegen
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, Utrecht, 3500BN, The Netherlands. .,Department of Sociology and Department of Human Geography, Utrecht University, P.O. Box 80.115, Utrecht, 3508 TC, The Netherlands.
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16
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Dinsdale E, Hannigan A, O'Connor R, O'Doherty J, Glynn L, Casey M, Hayes P, Kelly D, Cullen W, O'Regan A. Communication between primary and secondary care: deficits and danger. Fam Pract 2020; 37:63-68. [PMID: 31372649 DOI: 10.1093/fampra/cmz037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Timely and accurate communication between primary and secondary care is essential for delivering high-quality patient care. OBJECTIVE The aim of this study is to evaluate the content contained in both referral and response letters between primary and secondary care and measure this against the recommended national guidelines. METHODS Using an observational design, senior medical students and their general practice supervisors applied practice management software to identify 100 randomly selected adults, aged greater than 50 years, from a generated list of consults over a 2-year period (2013-2015). All data included in referral and response letters for these adults were examined and compared with the gold standard templates that were informed by international guidelines. RESULTS Data from 3293 referral letters and 2468 response letters from 68 general practices and 17 hospitals were analysed. The median time that had elapsed between a patient being referred and receiving a response letter was 4 weeks, ranging from 1 week for Emergency Department referral letters to 7 weeks for orthopaedic surgery referral letters. Referral letters included the reason for referral (98%), history of complaint (90%) and current medications (82%). Less commonly included were management prior to referral (65%) and medication allergies (57%). The majority of response letters included information on investigations (73%), results (70%) and follow-up plan (85%). Less commonly, response letters included medication changes (30%), medication lists (33%) and secondary diagnoses (13%). CONCLUSIONS Future research should be aimed at developing robust strategies to addressing communication gaps reported in this study.
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Affiliation(s)
- Elsa Dinsdale
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Ailish Hannigan
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Ray O'Connor
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Jane O'Doherty
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Monica Casey
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Peter Hayes
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Dervla Kelly
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Walter Cullen
- School of Medicine, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Andrew O'Regan
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
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17
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Scaioli G, Schäfer WLA, Boerma WGW, Spreeuwenberg P, van den Berg M, Schellevis FG, Groenewegen PP. Patients' perception of communication at the interface between primary and secondary care: a cross-sectional survey in 34 countries. BMC Health Serv Res 2019; 19:1018. [PMID: 31888614 PMCID: PMC6937702 DOI: 10.1186/s12913-019-4848-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor communication between general practitioners (GPs) and medical specialists can lead to poorer quality, and continuity, of care. Our study aims to assess patients' perceptions of communication at the interface between primary and secondary care in 34 countries. It will analyse, too, whether this communication is associated with the organisation of primary care within a country, and with the characteristics of GPs and their patients. METHODS We conducted a cross-sectional survey among patients in 34 countries. Following a GP consultation, patients were asked two questions. Did they take to understand that their GP had informed medical specialists about their illness upon referral? And, secondly, did their GP know the results of the treatment by a medical specialist? We used multi-response logistic multilevel models to investigate the association of factors related to primary care, the GP, and the patient, with the patients' perceptions of communication at the interface between primary and secondary care. RESULTS In total, 61,931 patients completed the questionnaire. We found large differences between countries, in both the patients' perceptions of information shared by GPs with medical specialists, and the patients' perceptions of the GPs' awareness of the results of treatment by medical specialists. Patients whose GPs stated that they 'seldom or never' send referral letters, also less frequently perceived that their GP communicated with their medical specialists about their illness. Patients with GPs indicating they 'seldom or never' receive feedback from medical specialists, indicated less frequently that their GP would know the results of treatment by a medical specialist. Moreover, patients with a personal doctor perceived higher rates of communication in both directions at the interface between primary and secondary care. CONCLUSION Generally, patients perceive there to be high rates of communication at the interface between primary and secondary care, but there are large differences between countries. Policies aimed at stimulating personal doctor arrangements could, potentially, enhance the continuity of care between primary and secondary care.
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Affiliation(s)
- Giacomo Scaioli
- Department of Public Health Sciences, University of Turin, Piazza Polonia, 94, 10126, Torino, Italy
| | - Willemijn L A Schäfer
- Department of Surgery, Northwestern University, Feinberg School of Medicine, 633 N. St Clair Street, Chicago, IL, 60611, USA
| | - Wienke G W Boerma
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands
| | - Peter Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands
| | - Michael van den Berg
- Department of Public Health, Amsterdam Public Health Research Institute, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - François G Schellevis
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands.,Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Peter P Groenewegen
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands. .,Department of Sociology, P.O. Box 80.115, 3508 TC, Utrecht, The Netherlands. .,Department of Human Geography, Utrecht University, P.O. Box 80.115, 3508 TC, Utrecht, The Netherlands.
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18
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Secure Provider-to-Provider Communication With Electronic Health Record Messaging: An Educational Outreach Study. J Healthc Qual 2019; 40:283-291. [PMID: 29280777 DOI: 10.1097/jhq.0000000000000115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION With increasing electronic health record (EHR) use, providers are talking less with one another. Now, many rely on EHRs, informal emails, or texts, introducing fragmentation and new data security challenges with new communication strategies. We aimed to examine the impact of a physician champion educational outreach intervention to promote electronic provider-to-provider communication in a large academic multispecialty group. METHODS Physician champions provided educational outreach to 16 academic departments, using 10-minute case-based presentations. Online surveys assessed communication preferences and practices. Electronic health record queries counted EHR messaging use before and after intervention. Descriptive statistics compared responses by specialty (z-test). Paired responses with pre-post data were compared using chi-square tests. Time series analysis assessed EHR messaging rates before intervention versus after intervention. RESULTS Five hundred seventeen providers responded to the postoutreach survey. Eighty-six percent were familiar with EHR messaging tool and 78% knew how to use it after intervention. Among practitioner groups, Family Medicine preferred EHR messaging the most (62%). Groups who declined outreach least preferred it (26%). Among 88 respondents with paired pre-post intervention surveys, familiarity rose (79-96%), and self-reported use increased (66-88%). CONCLUSIONS Physician champion educational outreach increased the use of the secure provider-to-provider EHR messaging tool.
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19
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Drivers of referrals to a children's hospital neonatal-infant intensive care unit. J Perinatol 2019; 39:295-299. [PMID: 30573751 DOI: 10.1038/s41372-018-0297-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 10/01/2018] [Accepted: 11/27/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Evaluate the outreach program of a regional NICU for referral satisfaction, drivers and barriers, preferences for service methods, outreach communication, and education. STUDY DESIGN To point out prevalence assessment of preferences, referral reasons, satisfaction and general feedback by regional neonatologists implemented by electronic survey using either multiple-choice or Likert scale questions. Survey questions were derived via consensus of the outreach program team. RESULTS A 100% response rate was achieved from 136 neonatologists. Over 90% of the respondents indicated either increased or unchanged referral rates and answered "maybe" or "definitely satisfied" with the outreach program. Insurance, bed availability, excellence in subspecialty support, and communication from neonatologists were important referral factors. Research reputation was not a significant driver. Case conferences at referral hospitals and program newsletters were the preferred education methods. CONCLUSIONS Advanced subspecialty services, communication with referring neonatologists, and access to the referral system are important drivers of satisfaction for referrals to our quaternary NICU.
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20
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Rea CJ, Wenren LM, Tran KD, Zwemer E, Mallon D, Bernson-Leung M, Samuels RC, Toomey SL. Shared Care: Using an Electronic Consult Form to Facilitate Primary Care Provider-Specialty Care Coordination. Acad Pediatr 2018; 18:797-804. [PMID: 29625232 DOI: 10.1016/j.acap.2018.03.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 03/14/2018] [Accepted: 03/24/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The quality of children's health is compromised by poor care coordination between primary care providers (PCPs) and specialists. Our objective was to determine how an electronic consultation and referral system impacts referral patterns and PCP-specialist communication. METHODS The primary care clinic at Boston Children's Hospital piloted an electronic referral and consultation system with the neurology and gastroenterology departments from April 1, 2014, to October 31, 2016. PCPs completed an electronic consult form, and if needed, specialists replied with advice or facilitated expedited appointments. Specialist response times, referral rates, wait times, and completion rates for specialty visits were tracked. PCPs and specialists also completed a survey to evaluate feasibility and satisfaction. RESULTS A total of 82 PCPs placed 510 consults during the pilot period. Specialists responded to 88% of requests within 3 business days. Eighteen percent of specialty visits were deferred and 21% were expedited. Wait times for specialty appointments to both departments significantly decreased, from 48 to 34 days (P < .001), and completion rates improved from 58% to 70% (P < .01), but referral volumes remained stable (25 per month to 23 per month; P = .29). Most PCPs said the Shared Care system facilitated better communication with specialists (89%) and enabled them to provide superior patient care (92%). Specialists reported that the system required a minimal amount of time and enabled them to educate PCPs and triage referrals. CONCLUSIONS Implementation of an electronic referral and consultation system was feasible and provided timely access to specialty care, but did not affect referral volume. This system could serve as a model for other health care organizations and specialties.
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Affiliation(s)
- Corinna J Rea
- Division of General Pediatrics, Boston Children's Hospital, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Larissa M Wenren
- Division of General Pediatrics, Boston Children's Hospital, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass
| | - Katherine D Tran
- Division of General Pediatrics, Boston Children's Hospital, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass
| | - Eric Zwemer
- Division of General Pediatrics, Boston Children's Hospital, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Daniel Mallon
- Harvard Medical School, Boston, Mass; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass; Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass
| | - Miya Bernson-Leung
- Harvard Medical School, Boston, Mass; Department of Neurology, Boston Children's Hospital, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass
| | - Ronald C Samuels
- Division of General Pediatrics, Boston Children's Hospital, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Sara L Toomey
- Division of General Pediatrics, Boston Children's Hospital, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass; Harvard Medical School, Boston, Mass
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21
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Brooke BS, Slager SL, Swords DS, Weir CR. Patient and caregiver perspectives on care coordination during transitions of surgical care. Transl Behav Med 2018; 8:429-438. [PMID: 29800402 DOI: 10.1093/tbm/ibx077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Care coordination for patients with chronic disease commonly involves multiple transitions between primary care and surgical providers. These transitions often cross healthcare settings, providers, and information systems. We performed a cross-sectional qualitative study to gain a better understanding of the factors that influence how patients and caregivers perceive care coordination during transitions of surgical care. Eight focus groups were conducted among individuals from three different U.S. states who had experienced an episode of surgical care within the past year. We included patients who had undergone major surgery for a chronic condition, as well as caregivers. We used Atlas.ti qualitative software and engaged in an iterative process of thematic analysis of focus group transcripts. After five-rounds of review, five main themes emerged that define chronic care coordination for surgical patients and caregivers: (a) Care coordination is embedded in the unwritten social con tract patients share with their surgical providers; (b) Patients expect all surgical and nonsurgical healthcare providers to be "on the same page"; (c) Patients are frightened and vulnerable during surgical care transitions; (d) Patients need to have accurate expectations of the processes associated with care coordination; and (e) Care coordination relies upon establishing patient trust with their surgical team and needs to be continually reaffirmed. Surgical patients and caregivers expect care coordination processes to involve informatics infrastructure, patient education, and information exchange between providers. Unfortunately, these aspects of care coordination are often lacking during transitions. These findings have implications for designing patient-centered interventions to improve coordination of chronic care.
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Affiliation(s)
- Benjamin S Brooke
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Stacey L Slager
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Douglas S Swords
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Charlene R Weir
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, USA
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22
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Ahmed S, Almario CV, Chey WD, Robbins LA, Chang B, Ahn J, Ko J, Gu P, Siu A, Spiegel BMR. Electronic patient agenda forms: comparing agreement between the reason for specialty consultation reported by referring providers and patients. Inform Health Soc Care 2018; 44:105-113. [PMID: 29509054 DOI: 10.1080/17538157.2018.1437041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Little is known about the agreement between referring providers' reason for specialty evaluation and patients' understanding of why they are referred for consultation. Here, we compared the reason for consult (RFC) documented by referring providers during usual care vs. the perceived RFC independently reported by patients through an e-portal just prior to the specialist visit. METHODS We performed an observational study among patients referred for gastrointestinal (GI) evaluation. Patients referred to the specialty clinic submitted their self-reported RFC using an online patient agenda form prior to their visit. Therefore, each participant had a referring provider- and patient-documented RFC. Blinded physicians reviewed the RFCs in random order using a priori coding criteria. We then compared whether the provider and patient RFC pairs were concordant (i.e., ≥1 clinical topic[s] in the RFCs matched). RESULTS Sixty patients completed the e-portal prior to their visit, leading to 60 provider-patient RFC pairs. The RFC pairs were concordant in only 52% of cases. CONCLUSIONS There is poor agreement between referring providers' reason for GI referral and patients' understanding of why they are visiting the clinic. Future research examining whether electronic patient agenda forms impact diagnostic and management precision, patient satisfaction, and healthcare utilization is warranted.
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Affiliation(s)
- Shahzad Ahmed
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Christopher V Almario
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,b Division of Digestive and Liver Diseases , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,c Division of Health Services Research , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,d Division of Informatics , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,e Cedars-Sinai Center for Outcomes Research and Education (CS-CORE) , Los Angeles , CA , USA
| | - William D Chey
- f Division of Gastroenterology , University of Michigan , Ann Arbor , MI , USA
| | - Lori A Robbins
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,b Division of Digestive and Liver Diseases , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Bianca Chang
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Joseph Ahn
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Jeffrey Ko
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Phillip Gu
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Alvin Siu
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Brennan M R Spiegel
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,b Division of Digestive and Liver Diseases , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,c Division of Health Services Research , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,d Division of Informatics , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,e Cedars-Sinai Center for Outcomes Research and Education (CS-CORE) , Los Angeles , CA , USA
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Stub T, Quandt SA, Arcury TA, Sandberg JC, Kristoffersen AE. Complementary and conventional providers in cancer care: experience of communication with patients and steps to improve communication with other providers. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:301. [PMID: 28595577 PMCID: PMC5465600 DOI: 10.1186/s12906-017-1814-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/31/2017] [Indexed: 11/20/2022]
Abstract
Background Effective interdisciplinary communication is important to achieve better quality in health care. The aims of this study were to compare conventional and complementary providers’ experience of communication about complementary therapies and conventional medicine with their cancer patients, and to investigate how they experience interdisciplinary communication and cooperation. Method This study analyzed data from a self-administrated questionnaire. A total of 606 different health care providers, from four counties in Norway, completed the questionnaire. The survey was developed to describe aspects of the communication pattern among oncology doctors, nurses, family physicians and complementary therapists (acupuncturists, massage therapists and reflexologists/zone-therapists). Between-group differences were analyzed using chi-square, ANOVA and Fisher’s exact tests. Significance level was defined as p < 0.05 without adjustment for multiple comparisons. Result Conventional providers and complementary therapists had different patterns of communication with their cancer patients regarding complementary therapies. While complementary therapists advised their patients to apply both complementary and conventional modalities, medical doctors were less supportive of their patients’ use of complementary therapies. Of conventional providers, nurses expressed more positive attitudes toward complementary therapies. Opportunities to improve communication between conventional and complementary providers were most strongly supported by complementary providers and nurses; medical doctors were less supportive of such attempts. A number of doctors showed lack of respect for complementary therapists, but asked for more research, guidelines for complementary modalities and training in conventional medicine for complementary therapists. Conclusion For better quality of care, greater communication about complementary therapy use is needed between cancer patients and their conventional and complementary providers. In addition, more communication between conventional and complementary providers is needed. Nurses may have a crucial role in facilitating communication, as they are positive toward complementary therapies and they have more direct communication with patients about their treatment preferences.
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Klabunde CN, Haggstrom D, Kahn KL, Gray SW, Kim B, Liu B, Eisenstein J, Keating NL. Oncologists' perspectives on post-cancer treatment communication and care coordination with primary care physicians. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28070939 DOI: 10.1111/ecc.12628] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 12/01/2022]
Abstract
Post-treatment cancer care is often fragmented and of suboptimal quality. We explored factors that may affect cancer survivors' post-treatment care coordination, including oncologists' use of electronic technologies such as e-mail and integrated electronic health records (EHRs) to communicate with primary care physicians (PCPs). We used data from a survey (357 respondents; participation rate 52.9%) conducted in 2012-2013 among medical oncologists caring for patients in a large US study of cancer care delivery and outcomes. Oncologists reported their frequency and mode of communication with PCPs, and role in providing post-treatment care. Seventy-five per cent said that they directly communicated with PCPs about post-treatment status and care recommendations for all/most patients. Among those directly communicating with PCPs, 70% always/usually used written correspondence, while 36% always/usually used integrated EHRs; telephone and e-mail were less used. Eighty per cent reported co-managing with PCPs at least one post-treatment general medical care need. In multivariate-adjusted analyses, neither communication mode nor intensity were associated with co-managing survivors' care. Oncologists' reliance on written correspondence to communicate with PCPs may be a barrier to care coordination. We discuss new research directions for enhancing communication and care coordination between oncologists and PCPs, and to better meet the needs of cancer survivors post-treatment.
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Affiliation(s)
- C N Klabunde
- Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - D Haggstrom
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - K L Kahn
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,RAND Corporation, Santa Monica, CA, USA
| | - S W Gray
- Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - B Kim
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - B Liu
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - J Eisenstein
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - N L Keating
- Department of Health Care Policy, Harvard Medical School and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Esan O, Oladele O. Referral letters to the psychiatrist in Nigeria: is communication adequate? Afr Health Sci 2016; 16:1023-1026. [PMID: 28479895 DOI: 10.4314/ahs.v16i4.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Over half of patients with psychiatric disorders are first seen by primary care physicians before referral to the psychiatrist. An efficient referral system is, therefore, important to offering quality care to such patients. Communication between physicians is often sub-optimal and referral letters to specialists sometimes provide inadequate information. The current study's aim was to observe the prevalence of deficiencies in the referral letters to a department of psychiatry in a Nigerian teaching hospital. METHODS All referral letters to the Department of Psychiatry, University College Hospital Ibadan, Nigeria over a three- year period from January 1, 2010, to December 31, 2012, were retrieved and assessed for quality using the Consultation and Referral Request Letter Assessment Tool. RESULT A majority (>80%) of the referral letters had no information on the current medication list, relevant psychosocial history, outline of management to date, results of investigations to date, and known allergies. CONCLUSION Deficits in communication or information transfer through referral letters to the psychiatrist are common. Interventions such as the use of standardized formats for such letters may facilitate more efficient communication.
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Affiliation(s)
- Oluyomi Esan
- Department of Psychiatry, University of Ibadan, University College Hospital, PMB 5116, Ibadan, Nigeria. Telephone: +234 8033880312;
| | - Oluremi Oladele
- Department of Psychiatry, University College Hospital, PMB 5116, Ibadan, Nigeria. Telephone number: +2348034974959
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Stub T, Quandt SA, Arcury TA, Sandberg JC, Kristoffersen AE, Musial F, Salamonsen A. Perception of risk and communication among conventional and complementary health care providers involving cancer patients' use of complementary therapies: a literature review. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:353. [PMID: 27609097 PMCID: PMC5016861 DOI: 10.1186/s12906-016-1326-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/25/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Communication between different health care providers (conventional and complementary) and cancer patients about their use of complementary therapies affects the health and safety of the patients. The aim of this study was to examine the qualitative research literature on the perception of and communication about the risk of complementary therapies between different health care providers and cancer patients. METHODS Systematic searches in six medical databases covering literature from 2000 to 2015 were performed. The studies were accessed according to the level of evidence and summarized into different risk situations. Qualitative content analysis was used to analyze the text data, and the codes were defined before and during the data analysis. RESULTS Twenty-nine papers were included in the primary analysis and five main themes were identified and discussed. The main risk situations identified were 1. Differences in treatment concepts and philosophical values among complementary and conventional health care providers. 2. Adverse effects from complementary products and herbs due to their contamination/toxicity and interactions with conventional cancer treatment. 3. Health care physicians and oncologists find it difficult to recommend many complementary modalities due to the lack of scientific evidence for their effect. 4. Lack of knowledge and information about complementary and conventional cancer treatments among different health care providers. CONCLUSION The risk of consuming herbs and products containing high level of toxins is a considerable threat to patient safety (direct risk). At the same time, the lack of scientific evidence of effect for many complementary therapies and differences in treatment philosophy among complementary and conventional health care providers potentially hinder effective communication about these threats with mutual patients (indirect risk). As such, indirect risk may pose an additional risk to patients who want to combine complementary therapies with conventional treatment in cancer care. Health care providers who care for cancer patients should be aware of these risks.
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Affiliation(s)
- Trine Stub
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Division of Public Health Sciences, Winston-Salem, NC 27157 USA
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Present address: Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway
| | - Sara A. Quandt
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Division of Public Health Sciences, Winston-Salem, NC 27157 USA
| | - Thomas A. Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Joanne C. Sandberg
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Agnete E. Kristoffersen
- Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway
| | - Frauke Musial
- Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway
| | - Anita Salamonsen
- Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway
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Deldar K, Bahaadinbeigy K, Tara SM. Teleconsultation and Clinical Decision Making: a Systematic Review. Acta Inform Med 2016; 24:286-292. [PMID: 27708494 PMCID: PMC5037984 DOI: 10.5455/aim.2016.24.286-292] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/15/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The goal of teleconsultation is to omit geographical and functional distance between two or more geographically separated health care providers. The purpose of present study is to review and analyze physician-physician teleconsultations. METHOD The PubMed electronic database was searched. The primary search was done on January 2015 and was updated on December 2015. A fetch and tag plan was designed by the researchers using an online Zotero library. RESULTS 174 full-text articles of 1702 records met inclusion criteria. Teleconsultation for pediatric patients accounts for 14.36 percent of accepted articles. Surgery and general medicine were the most prevalent medical fields in the adults and pediatrics, respectively. Most teleconsultations were inland experiences (no=135), and the USA, Italy and Australia were the three top countries in this group. Non-specialists health care providers/centers were the dominant group who requested teleconsultation (no=130). Real time, store and forward, and hybrid technologies were used in 50, 31, and 16.7 percent of articles, respectively. The teleconsultation were reported to result in change in treatment plan, referral or evacuation rate, change in diagnosis, educational effects, and rapid decision making. Use of structured or semi-structured template had been noticed only in a very few articles. CONCLUSION The present study focused on the recent ten years of published articles on physician-physician teleconsultations. Our findings showed that although there are positive impacts of teleconsultation as improving patient management, still have gaps that need to be repaired.
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Affiliation(s)
- Kolsoum Deldar
- Student Research Committee, Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IR Iran
| | - Seyed Mahmood Tara
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Saini P, Chantler K, Kapur N. General practitioners' perspectives on primary care consultations for suicidal patients. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:260-269. [PMID: 25661202 DOI: 10.1111/hsc.12198] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 06/04/2023]
Abstract
Little is known about general practitioners' (GPs') perspectives, management of and interactions with suicidal patients prior to the patient's suicide. The aims of the study were to explore GPs' interpretations of patient communication and treatment in primary care leading up to suicide and to investigate the relationship between GPs and mental health services prior to a patient's suicide. Thirty-nine semi-structured interviews with GPs of people who had died by suicide were conducted as part of a retrospective study. Interviews were transcribed verbatim and analysed using a thematic approach. The following themes emerged from GP interviews: (i) GP interpretations of suicide attempts or self-harm; (ii) professional isolation; and (iii) GP responsibilities versus patient autonomy. GPs recruited for the study may have different views from GPs who have never experienced a patient suicide or who have experienced the death of a patient by suicide who was not under the care of specialist services. Our findings may not be representative of the rest of the United Kingdom, although many of the issues identified are likely to apply across services. This study highlighted the following recommendations for future suicide prevention in general practice: increasing GP awareness of suicide-related issues and improving training and risk assessment skills; removing barriers to accessing therapies and treatments needed in primary care; improving liaison and collaboration between services to provide better patient outcomes; and increasing awareness in primary care about why patients may not want treatments offered by focusing on each individual's situational context.
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Affiliation(s)
- Pooja Saini
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Khatidja Chantler
- School of Social Work, University of Central Lancashire, Preston, UK
| | - Navneet Kapur
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
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Barnett ML, Mehrotra A, Frolkis JP, Spinks M, Steiger C, Hehir B, Greenberg JO, Singh H. Implementation Science Workshop: Implementation of an Electronic Referral System in a Large Academic Medical Center. J Gen Intern Med 2016; 31:343-52. [PMID: 26556594 PMCID: PMC4762816 DOI: 10.1007/s11606-015-3516-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Michael L Barnett
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Health Care Policy, Harvard Medical School, 180A Longwood Ave., Boston, MA, 02115, USA.
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, 180A Longwood Ave., Boston, MA, 02115, USA
| | - Joseph P Frolkis
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Casey Steiger
- Brigham and Women's Physicians Organization, Boston, MA, USA
| | - Brandon Hehir
- Brigham and Women's Physicians Organization, Boston, MA, USA
| | - Jeffrey O Greenberg
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Physicians Organization, Boston, MA, USA
| | - Hardeep Singh
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
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Vermeir P, Vandijck D, Degroote S, Peleman R, Verhaeghe R, Mortier E, Hallaert G, Van Daele S, Buylaert W, Vogelaers D. Communication in healthcare: a narrative review of the literature and practical recommendations. Int J Clin Pract 2015; 69:1257-67. [PMID: 26147310 PMCID: PMC4758389 DOI: 10.1111/ijcp.12686] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/29/2015] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Effective and efficient communication is crucial in healthcare. Written communication remains the most prevalent form of communication between specialised and primary care. We aimed at reviewing the literature on the quality of written communication, the impact of communication inefficiencies and recommendations to improve written communication in healthcare. DESIGN Narrative literature review. METHODS A search was carried out on the databases PubMed, Web of Science and The Cochrane Library by means of the (MeSH)terms 'communication', 'primary health care', 'correspondence', 'patient safety', 'patient handoff' and 'continuity of patient care'. Reviewers screened 4609 records and 462 full texts were checked according following inclusion criteria: (1) publication between January 1985 and March 2014, (2) availability as full text in English, (3) categorisation as original research, reviews, meta-analyses or letters to the editor. RESULTS A total of 69 articles were included in this review. It was found that poor communication can lead to various negative outcomes: discontinuity of care, compromise of patient safety, patient dissatisfaction and inefficient use of valuable resources, both in unnecessary investigations and physician worktime as well as economic consequences. CONCLUSION There is room for improvement of both content and timeliness of written communication. The delineation of ownership of the communication process should be clear. Peer review, process indicators and follow-up tools are required to measure the impact of quality improvement initiatives. Communication between caregivers should feature more prominently in graduate and postgraduate training, to become engraved as an essential skill and quality characteristic of each caregiver.
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Affiliation(s)
- P Vermeir
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - D Vandijck
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Public Health, Ghent University Hospital, Ghent, Belgium
- Department of Business Economics, Hasselt University, Diepenbeek, Belgium
| | - S Degroote
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Public Health, Ghent University Hospital, Ghent, Belgium
| | - R Peleman
- Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - R Verhaeghe
- Department of Public Health, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - E Mortier
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - G Hallaert
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - S Van Daele
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - W Buylaert
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
- Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium
| | - D Vogelaers
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
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Vermeir P, Vandijck D, Degroote S, Ommeslag D, Van De Putte M, Heytens S, Reniers J, Hanoulle I, Peleman R, Vogelaers D. Mutual perception of communication between general practitioners and hospital-based specialists. Acta Clin Belg 2015; 70:350-6. [PMID: 26043268 DOI: 10.1179/2295333715y.0000000032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Communication between general practitioners (GPs) and specialists is an important aspect of qualitative care. Efficient communication exchange is essential and key in guaranteeing continuity of care. Inefficient communication is related to several negative outcomes, including patient harm. This study aimed to investigate the perception of GPs and hospital-based specialists in Belgium of the quality of their mutual communication. METHODS A cross-sectional study was conducted among GPs and specialists. Participants were asked to complete a validated questionnaire on several aspects of their mutual communication. RESULTS Response rates of 17.9% (343/1.912) for GPs and 17.3% (392/2.263) for specialists were obtained. Both specialists and GPs qualify their mutual telephone accessibility as suboptimal. Specialists think poorly of the GP referral letter, in contrast to GP perception. Eighty per cent of the GPs feel that specialists address their questions appropriately; specialists have a similar perception of their own performance. According to 16.7% of the specialists, GPs not always follow their recommendations. Contrarily, GPs rate their compliance much higher (90.7%). Less than half of the GPs feel that the specialists' letter arrives on time, whereas specialists have a different and a more positive perception. CONCLUSIONS GPs and specialists disagree on several aspects of their mutual communication. These include the perception of accessibility, in both directions, and of the timeliness of written communication. Feedback is positively appreciated, again in both directions. Nevertheless, specialists feel that uptake of their recommendations is insufficient. Hence, there may remain significant room for improvement, which could contribute significantly to continuity of care and patient safety.
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Affiliation(s)
- P Vermeir
- Department of General Internal Medicine, Ghent University Hospital , Belgium
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Zuchowski JL, Rose DE, Hamilton AB, Stockdale SE, Meredith LS, Yano EM, Rubenstein LV, Cordasco KM. Challenges in referral communication between VHA primary care and specialty care. J Gen Intern Med 2015; 30:305-11. [PMID: 25410884 PMCID: PMC4351287 DOI: 10.1007/s11606-014-3100-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 10/03/2014] [Accepted: 10/29/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Poor communication between primary care providers (PCPs) and specialists is a significant problem and a detriment to effective care coordination. Inconsistency in the quality of primary-specialty communication persists even in environments with integrated delivery systems and electronic medical records (EMRs), such as the Veterans Health Administration (VHA). OBJECTIVE The purpose of this study was to measure ease of communication and to characterize communication challenges perceived by PCPs and primary care personnel in the VHA, with a particular focus on challenges associated with referral communication. DESIGN The study utilized a convergent mixed-methods design: online cross-sectional survey measuring PCP-reported ease of communication with specialists, and semi-structured interviews characterizing primary-specialty communication challenges. PARTICIPANTS 191 VHA PCPs from one regional network were surveyed (54% response rate), and 41 VHA PCPs and primary care staff were interviewed. MAIN MEASURES/APPROACH PCP-reported ease of communication mean score (survey) and recurring themes in participant descriptions of primary-specialty referral communication (interviews) were analyzed. KEY RESULTS Among PCPs, ease-of-communication ratings were highest for women's health and mental health (mean score of 2.3 on a scale of 1-3 in both), and lowest for cardiothoracic surgery and neurology (mean scores of 1.3 and 1.6, respectively). Primary care personnel experienced challenges communicating with specialists via the EMR system, including difficulty in communicating special requests for appointments within a certain time frame and frequent rejection of referral requests due to rigid informational requirements. When faced with these challenges, PCPs reported using strategies such as telephone and e-mail contact with specialists with whom they had established relationships, as well as the use of an EMR-based referral innovation called "eConsults" as an alternative to a traditional referral. CONCLUSIONS Primary-specialty communication is a continuing challenge that varies by specialty and may be associated with the likelihood of an established connection already in place between specialty and primary care. Improvement in EMR systems is needed, with more flexibility for the communication of special requests. Building relationships between PCPs and specialists may also facilitate referral communication.
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Affiliation(s)
- Jessica L Zuchowski
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA,
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Watson BM, Jones L, Cretchley J. Time as a Key Topic in Health Professionals' Perceptions of Clinical Handovers. Glob Qual Nurs Res 2014; 1:2333393614550162. [PMID: 28462291 PMCID: PMC5342289 DOI: 10.1177/2333393614550162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/13/2014] [Indexed: 12/01/2022] Open
Abstract
Clinical handovers are an essential part of the daily care and treatment of hospital patients. We invoked a language and social psychology lens to investigate how different health professional groups discussed the communication problems and strengths they experienced in handovers. We conducted in-depth interviews with three different health professional groups within a large metropolitan hospital. We used Leximancer text analytics software as a tool to analyze the data. Results showed that time was of concern to all groups in both similar and diverse ways. All professionals discussed time management, time pressures, and the difficulties of coordinating different handovers. Each professional group had its own unique perceptions and priorities about handovers. Our findings indicated that health professionals understood what was required for handover improvement but did not have the extra capacity to alter their current environment. Hospital management, with clinicians, need to implement handover schedule processes that prioritize interprofessional representation.
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Affiliation(s)
| | - Liz Jones
- Griffith University, Brisbane, Queensland, Australia
| | - Julia Cretchley
- The University of Queensland, Brisbane, Queensland, Australia
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Sewell JL, Day LW, Tuot DS, Alvarez R, Yu A, Chen AH. A brief, low-cost intervention improves the quality of ambulatory gastroenterology consultation notes. Am J Med 2013; 126:732-8. [PMID: 23791206 PMCID: PMC3730533 DOI: 10.1016/j.amjmed.2013.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 02/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Effective communication between primary care providers and specialty providers is important to facilitate high-quality specialty care. Few studies have assessed the quality of communication from specialist to primary care providers or implemented interventions to improve quality. We developed a brief, low-cost intervention designed to improve the quality of ambulatory gastroenterology consultation notes written by fellows and nurse practitioners in our urban health care system. METHODS Six physicians (3 specialists and 3 primary care providers) scored pre- and postintervention notes using an objective quality assessment instrument that had excellent inter-rater reliability. They were blinded to note date, author, and pre/postintervention status. The primary outcome was improvement in Composite Quality Score, an objective, comprehensive assessment of quality. Secondary outcomes included improvements in 3 specific domains, and Global Quality Score (a subjective measure of quality). RESULTS Two hundred pre- and 200 postintervention notes written by 6 fellows and 2 nurse practitioners were included. Composite Quality Score improved from 3.74 (of 5) to 4.09 (P <.001 in adjusted analysis). All secondary outcomes improved in adjusted analyses as well. The largest increase was seen in Communication Domain (22% increase). Fellow-written notes had higher scores than nurse practitioner-written notes, but nurse practitioner-written notes improved to a greater degree. CONCLUSION A brief, low-cost intervention significantly improved the quality of ambulatory gastroenterology consultation notes written by fellows and nurse practitioners. Communication between primary care providers and specialists is an important area for further study.
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Affiliation(s)
- Justin L Sewell
- Center for Innovation in Access and Quality, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
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Stille CJ, Fischer SH, La Pelle N, Dworetzky B, Mazor KM, Cooley WC. Parent partnerships in communication and decision making about subspecialty referrals for children with special needs. Acad Pediatr 2013; 13:122-32. [PMID: 23356961 DOI: 10.1016/j.acap.2012.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 12/03/2012] [Accepted: 12/07/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe factors that influence parent-clinician partnerships in information exchange and shared decision making (SDM) when children with special health care needs are referred to subspecialists. METHODS We conducted focus groups with parents of children with special health care needs and pediatric primary care and subspecialty clinicians about how to include parents as partners in information exchange and SDM. Five parent and 5 clinician groups were held to identify themes to inform the development of interventions to promote parent partnerships; evaluate a prototype referral care plan and related parent supports as one example of a partnership tool; and compare the views of parents and clinicians. We used investigator triangulation and member checking to improve validity. RESULTS Nineteen parents and 23 clinicians participated. Parents discussed partnerships more easily than clinicians did, though clinicians offered more ideas as sessions progressed. Parents and clinicians agreed on the importance of 3-way communication and valued primary care involvement in all stages of referral and consultation. SDM was seen by all as important; clinicians cited difficulties inherent in discussing unclear options, while parents cited insufficient information as a barrier to understanding. Use of a brief referral care plan, with parent coaching, was embraced by all parents and most clinicians. Clinicians cited time pressures and interference with work flow as potential barriers to its use. CONCLUSIONS Parents and clinicians endorse partnership in referrals, though relatively greater enthusiasm from parents may signal the need for work in implementing this partnership. Use of a care plan to support parent engagement appears promising as a partnership tool.
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Affiliation(s)
- Christopher J Stille
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
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Toomey SL, Chien AT, Elliott MN, Ratner J, Schuster MA. Disparities in unmet need for care coordination: the national survey of children's health. Pediatrics 2013; 131:217-24. [PMID: 23339228 DOI: 10.1542/peds.2012-1535] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine (1) the proportion of parents who report a need for and receipt of effective care coordination for their child, (2) whether unmet care coordination needs differ by children with special health care needs (CSHCN) status and sociodemographic characteristics, and (3) whether having a personal provider or family-centered care mitigates disparities. METHODS This study was a cross-sectional analysis of the 2007 National Survey for Children's Health, a nationally representative survey of 91 642 parents. Outcome measures were parent report of need for and lack of effective care coordination. We also examined the effect of parent report of having a personal provider and family-centered care. We conducted weighted bivariate and multivariate analyses. RESULTS Forty-one percent of parents reported that their child needed care coordination. Among those who needed care coordination, 31% did not receive effective coordination. CSHCN (41%) were more likely than children without special health care needs (26%; P < .001) to have unmet care coordination needs. Latino (40%) and black (37%) children were more likely to have unmet needs than white (27%; P < .001) children. These patterns remained in multivariate analysis. Having a personal provider decreased the odds of having unmet need for care coordination but did not attenuate disparities. Receiving family-centered care mitigated disparities associated with race/ethnicity but not with health status or health insurance. CONCLUSIONS A considerable proportion of parents reported their child needed more care coordination than they received. This was especially true for parents of CSHCN and parents of black and Latino children. Interventions that enhance family-centered care might particularly contribute to reducing racial/ethnic disparities.
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Affiliation(s)
- Sara L Toomey
- MPhil, MSc, Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
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Koenig CJ, Maguen S, Daley A, Cohen G, Seal KH. Passing the baton: a grounded practical theory of handoff communication between multidisciplinary providers in two Department of Veterans Affairs outpatient settings. J Gen Intern Med 2013; 28:41-50. [PMID: 22868947 PMCID: PMC3539021 DOI: 10.1007/s11606-012-2167-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 04/11/2012] [Accepted: 06/25/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Handoffs are communication processes that enact the transfer of responsibility between providers across clinical settings. Prior research on handoff communication has focused on inpatient settings between provider teams and has emphasized patient safety. This study examines handoff communication within multidisciplinary provider teams in two outpatient settings. OBJECTIVE To conduct an exploratory study that describes handoff communication among multidisciplinary providers, to develop a theory-driven descriptive framework for outpatient handoffs, and to evaluate the strengths and weaknesses of different handoff types. DESIGN & SETTING Qualitative, in-depth, semi-structured interviews with 31 primary care, mental health, and social work providers in two Department of Veterans Affairs (VA) Medical Center outpatient clinics. APPROACH Audio-recorded interviews were transcribed and analyzed using Grounded Practical Theory to develop a theoretical model of and a descriptive framework for handoff communication among multidisciplinary providers. RESULTS Multidisciplinary providers reported that handoff decisions across settings were made spontaneously and without clear guidelines. Two situated values, clinic efficiency and patient-centeredness, shaped multidisciplinary providers' handoff decisions. Providers reported three handoff techniques along a continuum: the electronic handoff, which was the most clinically efficient; the provider-to-provider handoff, which balanced clinic efficiency and patient-centeredness; and the collaborative handoff, which was the most patient-centered. Providers described handoff choice as a practical response to manage constituent features of clinic efficiency (time, space, medium of communication) and patient-centeredness (information continuity, management continuity, relational continuity, and social interaction). We present a theoretical and descriptive framework to help providers evaluate differential handoff use, reflect on situated values guiding clinic communication, and guide future research. CONCLUSIONS Handoff communication reflected multidisciplinary providers' efforts to balance clinic efficiency with patient-centeredness within the constraints of day-to-day clinical practice. Evaluating the strengths and weaknesses among alternative handoff options may enhance multidisciplinary provider handoff decision-making and may contribute to increased coordination and continuity of care across outpatient settings.
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Affiliation(s)
- Christopher J Koenig
- Department of Medicine, San Francisco Veterans Administration Medical Center, University of California, San Francisco, 4150 Clement Street, 116P, San Francisco, CA 94121, USA.
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Esquivel A, Sittig DF, Murphy DR, Singh H. Improving the effectiveness of electronic health record-based referral processes. BMC Med Inform Decis Mak 2012; 12:107. [PMID: 22973874 PMCID: PMC3492108 DOI: 10.1186/1472-6947-12-107] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 08/24/2012] [Indexed: 02/08/2023] Open
Abstract
Electronic health records are increasingly being used to facilitate referral communication in the outpatient setting. However, despite support by technology, referral communication between primary care providers and specialists is often unsatisfactory and is unable to eliminate care delays. This may be in part due to lack of attention to how information and communication technology fits within the social environment of health care. Making electronic referral communication effective requires a multifaceted “socio-technical” approach. Using an 8-dimensional socio-technical model for health information technology as a framework, we describe ten recommendations that represent good clinical practices to design, develop, implement, improve, and monitor electronic referral communication in the outpatient setting. These recommendations were developed on the basis of our previous work, current literature, sound clinical practice, and a systems-based approach to understanding and implementing health information technology solutions. Recommendations are relevant to system designers, practicing clinicians, and other stakeholders considering use of electronic health records to support referral communication.
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Affiliation(s)
- Adol Esquivel
- Department of Clinical Effectiveness and Performance Measurement, St. Luke’s Episcopal Health System, Houston, TX, USA
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Abel GA, Friese CR, Neville BA, Wilson KM, Hastings BT, Earle CC, Keating NL, Richardson LC. Referrals for suspected hematologic malignancy: a survey of primary care physicians. Am J Hematol 2012; 87:634-6. [PMID: 22473854 DOI: 10.1002/ajh.23172] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 02/17/2012] [Accepted: 02/21/2012] [Indexed: 12/31/2022]
Abstract
Little is known about referrals from primary care providers (PCPs) for suspected hematologic malignancies, including their clinical triggers and frequency. A random sample of 190 Massachusetts PCPs were presented with a vignette concerning a patient with a new finding of moderate anemia, asked how they would respond, and then asked what they would do if the patient returned with persistent anemia plus one additional sign or symptom. We also asked about referral behaviors for suspected hematologic malignancies during the prior year. A total of 134 (70.5%) PCPs responded. At first anemia presentation,only 3.8% reported referring to hematology. The development of a second sign or symptom yielded higher referral rates: pancytopenia 588.7%, leukopenia 5 63.9%, thrombocytopenia 5 63.9%, lymphadenopathy 5 42.9%, leukocytosis 5 37.6%, night sweats 5 25.6%, and weight loss 5 23.3%. The median yearly number (interquartile range) of patients PCPs reported suspecting of having hematologic malignancy was 5 (3, 10), and the median formally referred was 5 (3, 10). We conclude that anemia plus signs and symptoms suggestive of myelodysplasia or leukemia (compared with those suggestive of lymphoma) are more likely to prompt hematology referral. In addition, given their rarity,the numbe
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Affiliation(s)
- Gregory A Abel
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
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Yee J, Unsworth K, Suskin N, Reid RD, Jamnik V, Grace SL. Primary care provider perceptions of intake transition records and shared care with outpatient cardiac rehabilitation programs. BMC Health Serv Res 2011; 11:231. [PMID: 21939563 PMCID: PMC3189395 DOI: 10.1186/1472-6963-11-231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 09/23/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While it is recommended that records are kept between primary care providers (PCPs) and specialists during patient transitions from hospital to community care, this communication is not currently standardized. We aimed to assess the transmission of cardiac rehabilitation (CR) program intake transition records to PCPs and to explore PCPs' needs in communication with CR programs and for intake transition record content. METHOD 144 PCPs of consenting enrollees from 8 regional and urban Ontario CR programs participated in this cross-sectional study. Intake transition records were tracked from the CR program to the PCP's office. Sixty-six PCPs participated in structured telephone interviews. RESULTS Sixty-eight (47.6%) PCPs received a CR intake transition record. Fifty-eight (87.9%) PCPs desired intake transition records, with most wanting it transmitted via fax (n = 52, 78.8%). On a 5-point Likert scale, PCPs strongly agreed that the CR transition record met their needs for providing patient care (4.32 ± 0.61), with 48 (76.2%) reporting that it improved their management of patients' cardiac risk. PCPs rated the following elements as most important to include in an intake transition record: clinical status (4.67 ± 0.64), exercise test results (4.61 ± 0.52), and the proposed patient care plan (4.59 ± 0.71). CONCLUSIONS Less than half of intake transition records are reaching PCPs, revealing a large gap in continuity of patient care. PCP responses should be used to develop an evidence-based intake transition record, and procedures should be implemented to ensure high-quality transitional care.
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Affiliation(s)
- Jonathan Yee
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, Ontario, Canada
| | | | | | - Robert D Reid
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Veronica Jamnik
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, Ontario, Canada
| | - Sherry L Grace
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, Ontario, Canada
- Department of Women's Health, Toronto General Hospital, Toronto, Ontario, Canada
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Hysong SJ, Esquivel A, Sittig DF, Paul LA, Espadas D, Singh S, Singh H. Towards successful coordination of electronic health record based-referrals: a qualitative analysis. Implement Sci 2011; 6:84. [PMID: 21794109 PMCID: PMC3199858 DOI: 10.1186/1748-5908-6-84] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 07/27/2011] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Successful subspecialty referrals require considerable coordination and interactive communication among the primary care provider (PCP), the subspecialist, and the patient, which may be challenging in the outpatient setting. Even when referrals are facilitated by electronic health records (EHRs) (i.e., e-referrals), lapses in patient follow-up might occur. Although compelling reasons exist why referral coordination should be improved, little is known about which elements of the complex referral coordination process should be targeted for improvement. Using Okhuysen & Bechky's coordination framework, this paper aims to understand the barriers, facilitators, and suggestions for improving communication and coordination of EHR-based referrals in an integrated healthcare system. METHODS We conducted a qualitative study to understand coordination breakdowns related to e-referrals in an integrated healthcare system and examined work-system factors that affect the timely receipt of subspecialty care. We conducted interviews with seven subject matter experts and six focus groups with a total of 30 PCPs and subspecialists at two tertiary care Department of Veterans Affairs (VA) medical centers. Using techniques from grounded theory and content analysis, we identified organizational themes that affected the referral process. RESULTS Four themes emerged: lack of an institutional referral policy, lack of standardization in certain referral procedures, ambiguity in roles and responsibilities, and inadequate resources to adapt and respond to referral requests effectively. Marked differences in PCPs' and subspecialists' communication styles and individual mental models of the referral processes likely precluded the development of a shared mental model to facilitate coordination and successful referral completion. Notably, very few barriers related to the EHR were reported. CONCLUSIONS Despite facilitating information transfer between PCPs and subspecialists, e-referrals remain prone to coordination breakdowns. Clear referral policies, well-defined roles and responsibilities for key personnel, standardized procedures and communication protocols, and adequate human resources must be in place before implementing an EHR to facilitate referrals.
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Affiliation(s)
- Sylvia J Hysong
- Houston VA Health Services Research & Development Center of Excellence, Michael E, DeBakey Veterans Affairs Medical Center, Houaron, Texas, USA.
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Gröber-Grätz D, Mosshammer D, Bölter R, Ose D, Joos S, Natanzon I. [Which criteria affect the cooperation between general practitioners and specialists in ambulatory care? A qualitative study about general practitioners' perception]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2011; 105:446-51. [PMID: 21843847 DOI: 10.1016/j.zefq.2011.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 06/17/2011] [Accepted: 06/22/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Good cooperation between physicians is an essential requirement for quality health care. General practitioners (GPs) have a key role in coordinating the various levels of care and physician contacts. Within the scope of the "InteraKtion" study of the Competence Centre of General Practice Baden-Wuerttemberg GPs were interviewed about their experiences and opinions regarding their cooperation with specialists. The aim of this study was to identify criteria and barriers of the referral process. METHODS 22 semi-structured interviews were conducted among GPs in Heidelberg, Tuebingen and Ulm. Data analysis was carried out using ATLAS.ti according to the qualitative content analysis by P. Mayring. RESULTS From the GPs' point of view, the criteria for referral to specialists include: specialists' medical skills, good doctor-patient relationship and patient satisfaction. In addition, the willingness to arrange short-term appointments in urgent cases, timely diagnosis and adequate communication were mentioned. The following barriers were pointed out: long appointment wait times and the specialists' increased provision of Individual Healthcare Services. CONCLUSION These results indicate that GPs have clear criteria for referral to specialists. These findings should find their way into future quantitative studies to explore the weighting of the criteria and barriers discussed here. Joint training activities or quality circles could improve the personal contact between GPs and specialists working in the same region.
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Abstract
CONTEXT In the United States, more than a third of patients are referred to a specialist each year, and specialist visits constitute more than half of outpatient visits. Despite the frequency of referrals and the importance of the specialty-referral process, the process itself has been a long-standing source of frustration among both primary care physicians (PCPs) and specialists. These frustrations, along with a desire to lower costs, have led to numerous strategies to improve the specialty-referral process, such as using gatekeepers and referral guidelines. METHODS This article reviews the literature on the specialty-referral process in order to better understand what is known about current problems with the referral process and what solutions have been proposed. The article first provides a conceptual framework and then reviews prior literature on the referral decision, care coordination including information transfer, and access to specialty care. FINDINGS PCPs vary in their threshold for referring a patient, which results in both the underuse and the overuse of specialists. Many referrals do not include a transfer of information, either to or from the specialist; and when they do, it often contains insufficient data for medical decision making. Care across the primary-specialty interface is poorly integrated; PCPs often do not know whether a patient actually went to the specialist, or what the specialist recommended. PCPs and specialists also frequently disagree on the specialist's role during the referral episode (e.g., single consultation or continuing co-management). CONCLUSIONS There are breakdowns and inefficiencies in all components of the specialty-referral process. Despite many promising mechanisms to improve the referral process, rigorous evaluations of these improvements are needed.
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Affiliation(s)
- Ateev Mehrotra
- University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA.
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Singh H, Esquivel A, Sittig DF, Murphy D, Kadiyala H, Schiesser R, Espadas D, Petersen LA. Follow-up actions on electronic referral communication in a multispecialty outpatient setting. J Gen Intern Med 2011; 26:64-9. [PMID: 20848235 PMCID: PMC3024094 DOI: 10.1007/s11606-010-1501-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 04/01/2010] [Accepted: 08/18/2010] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Electronic health records (EHR) enable transmission and tracking of referrals between primary-care practitioners (PCPs) and subspecialists. We used an EHR to examine follow-up actions on electronic referral communication in a large multispecialty VA facility. METHODS We retrieved outpatient referrals to five subspecialties between October 2006 and December 2007, and queried the EHR to determine their status: completed, discontinued (returned to PCP), or unresolved (no action taken by subspecialist). All unresolved referrals, and random samples of discontinued and completed referrals were reviewed to determine whether subspecialists took follow-up actions (i.e., schedule appointments anytime in the future) within 30 days of referral-receipt. For referrals without timely follow-up, we determined whether inaction was supported by any predetermined justifiable reasons or associated with certain referral characteristics. We also reviewed if PCPs took the required action on returned information. RESULTS Of 61,931 referrals, 22,535 were discontinued (36.4%), and 474 were unresolved (0.8%). We selected 412 discontinued referrals randomly for review. Of these, 52% lacked follow-up actions within 30 days. Appropriate justifications for inaction were documented in 69.8% (150/215) of those without action and included lack of prerequisite testing by the PCP and subspecialist opinion that no intervention was required despite referral. We estimated that at 30 days, 6.3% of all referrals were associated with an unexplained lack of follow-up actions by subspecialists. Conversely, 7.4% of discontinued referrals returned to PCPs were associated with an unexplained lack of follow-up. CONCLUSIONS Although the EHR facilitates transmission of valuable information at the PCP-subspecialist interface, unexplained communication breakdowns in the referral process persist in a subset of cases.
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Affiliation(s)
- Hardeep Singh
- Houston VA HSR&D Center of Excellence and The Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
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Horwitz SK, Horwitz IB, Barshes NR. Addressing dysfunctional relations among healthcare teams: improving team cooperation through applied organizational theories. Adv Health Care Manag 2011; 10:173-97. [PMID: 21887945 DOI: 10.1108/s1474-8231(2011)0000010017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Previous research has demonstrated that communication failure and interpersonal conflicts are significant impediments among health-care teams to assess complex information and engage in the meaningful collaboration necessary for optimizing patient care. Despite the prolific research on the role of effective teamwork in accomplishing complex tasks, such findings have been traditionally applied to business organizations and not medical contexts. This chapter, therefore, reviews and applies four theories from the fields of organizational behavior (OB) and organization development (OD) as potential means for improving team interaction in health-care contexts. This study is unique in its approach as it addresses the long-standing problems that exist in team communication and cooperation in health-care teams by applying well-established theories from the organizational literature. The utilization and application of the theoretical constructs discussed in this work offer valuable means by which the efficacy of team work can be greatly improved in health-care organizations.
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Affiliation(s)
- Sujin K Horwitz
- Cameroon School of Business, University of St. Thomas, Houston, TX, USA
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Kim-Hwang JE, Chen AH, Bell DS, Guzman D, Yee HF, Kushel MB. Evaluating electronic referrals for specialty care at a public hospital. J Gen Intern Med 2010; 25:1123-8. [PMID: 20512531 PMCID: PMC2955477 DOI: 10.1007/s11606-010-1402-1] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 04/08/2010] [Accepted: 05/01/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND Poor communication between referring clinicians and specialists may lead to inefficient use of specialist services. San Francisco General Hospital implemented an electronic referral system (eReferral) that facilitates iterative pre-visit communication between referring and specialty clinicians to improve the referral process. OBJECTIVE The purpose of the study was to determine the impact of eReferral (compared with paper-based referrals) on specialty referrals. DESIGN The study was based on a visit-based questionnaire appended to new patient charts at randomly selected specialist clinic sessions before and after the implementation of eReferral. PARTICIPANTS Specialty clinicians. MAIN MEASURES The questionnaire focused on the self-reported difficulty in identifying referral question, referral appropriateness, need for and avoidability of follow-up visits. KEY RESULTS We collected 505 questionnaires from speciality clinicians. It was difficult to identify the reason for referral in 19.8% of medical and 38.0% of surgical visits using paper-based methods vs. 11.0% and 9.5% of those using eReferral (p-value 0.03 and <0.001). Of those using eReferral, 6.4% and 9.8% of medical and surgical referrals using paper methods vs. 2.6% and 2.1% were deemed not completely appropriate (p-value 0.21 and 0.03). Follow-up was requested for 82.4% and 76.2% of medical and surgical patients with paper-based referrals vs. 90.1% and 58.1% of eReferrals (p-value 0.06 and 0.01). Follow-up was considered avoidable for 32.4% and 44.7% of medical and surgical follow-ups with paper-based methods vs. 27.5% and 13.5% with eReferral (0.41 and <0.001). CONCLUSION Use of technology to promote standardized referral processes and iterative communication between referring clinicians and specialists has the potential to improve communication between primary care providers and specialists and to increase the effectiveness of specialty referrals.
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Affiliation(s)
- Judy E. Kim-Hwang
- Internal Medicine Residency Program, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA USA
- University of California San Francisco School of Medicine, San Francisco, CA USA
| | - Alice Hm Chen
- Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA USA
- Center for Specialty Access and Quality, San Francisco General Hospital and University of California San Francisco, San Francisco, CA USA
- Department of Medicine, University of California San Francisco, San Francisco, CA USA
| | - Douglas S. Bell
- RAND Corporation, Santa Monica, CA USA
- Department of Medicine, University of California, Los Angeles, CA USA
| | - David Guzman
- Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA USA
| | - Hal F. Yee
- Center for Specialty Access and Quality, San Francisco General Hospital and University of California San Francisco, San Francisco, CA USA
- Department of Medicine, University of California San Francisco, San Francisco, CA USA
| | - Margot B. Kushel
- Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA USA
- Department of Medicine, University of California San Francisco, San Francisco, CA USA
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Knight L. Research Report: How do GPs make referral and treatment decisions when patients present with mental health problems? COUNSELLING PSYCHOLOGY QUARTERLY 2010. [DOI: 10.1080/09515070310001610092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
RATIONALE, AIMS AND OBJECTIVES Clinical care often requires referrals, but many referrals never result in completed evaluations. We determined the extent to which referral-based consultations were completed in a US medical institution. Factors associated with completion were identified. METHOD In a cross-sectional analysis, we analysed billing records and electronic and paper-based medical records for patients aged 65 years or older receiving health care between July 2000 and June 2002 in an integrated, urban, tax-supported medical institution on an academic campus. All referrals in ambulatory care, scheduling of consultation within 180 days, and completion were assessed. We conducted a multivariate survival analysis to identify factors associated with completion. RESULTS We identified 6785 patients with encounters. Mean age was 72 years, and, of the participants, 66% were women, 55% were African-American and 32% were Medicaid eligible. Of the 81% with at least one primary-care visit in ambulatory care, 63% had at least one referral. About 8% of referrals required multiple orders before an appointment was scheduled. Among 7819 orders for specialty consultation in ambulatory care, 71% led to appointments, and 70% of appointments were kept (completed = 0.71*0.70 or 50%). Scheduling of consultations varied (12% to 90%) by specialty. Medicare, singular orders, location of referral and lack of hospitalization were independently significantly associated with scheduling of appointments. CONCLUSIONS Among older adults studied, half of medical specialty referrals were not completed. Multiple process errors, including missing information, misguided referrals and faulty communications, likely contribute to these results. Information systems offer important opportunities to improve the referrals process.
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Affiliation(s)
- Michael Weiner
- Indiana University Center for Aging Research, Regenstrief Institute, Incorporated 410 West 10th Street, Suite 2000, Indianapolis, Indiana 46202-3012, USA.
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Kameg K, Mitchell AM, Clochesy J, Howard VM, Suresky J. Communication and human patient simulation in psychiatric nursing. Issues Ment Health Nurs 2009; 30:503-8. [PMID: 19591024 DOI: 10.1080/01612840802601366] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Communication is an integral component of nursing education and has been shown to improve health outcomes, patient compliance, and patient satisfaction. Psychiatric nursing emphasizes knowledge and utilization of communication skills. Nursing students often express anxiety and lack of confidence regarding communicating with patients diagnosed with psychiatric illnesses. Human patient simulation is one method that may be used for students to practice and become proficient with communication skills in a simulated environment. The authors of this article provide an overview of communication and psychiatric nursing as well as review of the current research related to the use of human patient simulation in nursing education.
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Affiliation(s)
- Kirstyn Kameg
- Robert Morris University, Moon Township, PA 15108, USA.
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