The COMMONWEALTH FUND In The Literature Highlights from Commonwealth Fund-Supported Studies in Professional Journals Primary  Care  Physicians  in  Ten  Countries  Report  Challenges  Caring  for  Patients   with  Complex  Health  Needs   Synopsis   Nearly   one-­‐‑quarter   of   primary   care   physicians   in   the   United   States   report  they  are  not  prepared  to  care  for  the  sickest  and  frailest  patients,   Dec..  7,  2015   and  84  percent  say  they  are  not  well  prepared  to  manage  patients  with   Authors    Robin  Osborn,  Donald   Moulds,  Eric  C.  Schneider,  Michelle  M.   serious   mental   illness,   according   to   a   new   10-­‐‑nation   survey.   The   Doty,  David  Squires,  and  Dana  O.   findings   suggest   the   U.S.   may   need   to   do   more   to   strengthen   primary   Sarnak   care  and  employ  new  ideas  shown  to  be  effective  in  other  countries.   Journal    Health  Affairs,  Dec.  2015   The Issue Contact    Robin  Osborn,  vice  president   of  the  International  Health  Policy  and   Despite   having   a   younger   population   than   many   other   developed   Practice  Innovations  program,  The   countries,  the  U.S.  has  a  higher  share  of  patients  with  multiple  chronic   Commonwealth  Fund   conditions,   severe   mental   illnesses,   and   other   significant   health   care   ro@cmwf.org   challenges.   As   a   group,   these   patients   account   for   a   disproportionate   Access  to  full  article.   share  of  health  care  spending,  yet  they  do  not  fare  well—in  part  because   the   nation’s   primary   care   practices   are   ill   prepared   to   meet   their   needs.   The   2015   Commonwealth   Fund   International  Health  Policy  Survey  of  Primary  Care  Physicians  surveyed  doctors  in  10  countries  to  compare   their   experiences   in   providing   care   to   patients   with   complex   problems,   using   health   information   technology,   and  coordinating  care  outside  of  office  settings,  among  other  activities.   Key Findings •   Across   the   10   countries   surveyed,   primary   care   doctors   reported   that   their   practices   struggle   to   coordinate   care   and   communicate   with   other   health   and  social  services  providers.   •   Doctors   also   questioned   their   preparedness  to  care  for  patients   with   challenging   issues   such   as   dementia   and   severe   mental   illness,   as   well   as   those   who     need   long-­‐‑term   home   care     or   community-­‐‑based   social   services.  Doctors  in  Germany  and   the   Netherlands   were   the   most   confident  in  their  ability  to  meet   these  needs,  with  only  12  percent   saying  they  felt  unprepared.   •   Within   the   U.S.,   24  percent   of   primary   care   doctors   said   their   practices   are   not   equipped   to   manage   care   for  patients  with  multiple  chronic  conditions,  and  84  percent  said  they  are  not  prepared  for  managing  care   of  patients  with  severe  mental  health  problems.   •   In   the   U.S.,   only   one   of   three   primary   care   doctors   (31%)   said   they   were   notified   when   a   patient   is   discharged  from  the  hospital  or  seen  in  an  emergency  department  (ED).  In  the  Netherlands,  which  does   best  in  this  area,  69  percent  of  doctors  reported  they  were  always  notified  at  discharge.   •   Across  most  countries,  about  half  of  doctors  said  their  practices  routinely  coordinate  care  with  home  care   providers.  In  the  U.S.,  just  over  40  percent  reported  communicating  with  social  service  providers  on  issues   related  to  housing,  meals,  and  transportation,  compared  with  65  percent  of  practices  in  the  U.K.   •   Slightly   less   than   40   percent   of   U.S.   primary   care   doctors   had   made   arrangements   for   patients   to   get     after-­‐‑hours  care  without  going  to  the  ED—the  lowest  rate  in  the  survey.  This  contrasts  with  94  percent  in   the   Netherlands,   92   percent   in   New   Zealand,   and   89   percent   in   the   U.K.   Only   6   percent   of   physicians   surveyed   in   the   U.S.   were   able   to   make   home   visits,   compared   with   more   than   80   percent   in   the   Netherlands  and  the  U.K.   •   Use  of  health  information  technology  was  a  bright  spot  for  the  U.S.  Use  of  electronic  health  records  (EHRs)   has  tripled  since  2006.  Fifty-­‐‑seven  percent  of  U.S.  primary  care  practices  reported  communicating  with   patients   via   email   and   60   percent   allow   patients   to   access   their   medical   record   electronically.   Only   52   percent  of  doctors  reported  being  satisfied  with  their  EHRs,  however.   The Big Picture While  U.S.  primary  care  practices  lag  some  other  countries  in  their  readiness  to  manage  the  care  of  high-­‐‑needs   patients,   the   Affordable   Care   Act   has   introduced   provisions   that   encourage   the   health   care   industry   to   invest   in   new   ways   of   providing   and   paying   for   health   care,   such   as   medical   homes   and   accountable   care   organizations.   These   efforts   are   nascent,   however,   and   delivery   systems   have   been   slow   to   respond   to   them,   the  authors  note.   About the Study Researchers   analyzed   survey   responses   from   more   than   11,000   primary   care   doctors   in   Australia,   Canada,   Germany,   the   Netherlands,   New   Zealand,   Norway,   Sweden,   Switzerland,   the   United   Kingdom,   and   the   United   States.  Response  rates  ranged  from  19  percent  in  Germany  to  47  percent  in  Sweden.   The Bottom Line To  ensure  affordable,  high-­‐‑quality  health  care  for  sick  and  complex  patients,  the  U.S.  must  strengthen  its   primary  care  infrastructure.  This  includes  making  it  easier  for  patients  to  get  care  on  nights  and  weekends,   facilitating  communication  among  providers,  and  enabling  access  to  social  services.   R. Osborn, D. Moulds, E. C. Schneider et al., “Primary Care Physicians in Ten Countries Report Challenges Caring for Patients with Complex Health Needs,” Health Affairs, Dec. 2015 34(12):2104–12. ______________________________________________________________________________________________________________________________________________________________ This  summary  was  prepared  by  Sarah  Klein.