US Care Coordination Lags Behind Ten Comparable Nations, Study Says

When compared with other comparable, high-income nations, the United States often lags on healthcare, and primary care coordination is no exception. A new study in the Annals of Family Medicine, compared 11 countries and found that the US has the highest rate of poor primary care coordination. In order to better care for a growing younger, chronically ill population, the US healthcare system will need to be redesigned, the authors concluded.

Optimizing the relationship between patients and their physician increases patient satisfaction and medication adherence, while reducing hospitalizations. However, there is not a lot of data on the effect of a patient’s relationship with his or her primary care physician on care coordination.

“Implementing such programs has become increasingly difficult in many countries because of multiple factors that include a shortage of primary care physicians (PCPs), health professional workloads, underfunding of primary care by governments, fragmentation between sectors of healthcare, and the burden of disease and risk profile of the population,” the authors wrote.

The researchers used the 2013 Commonwealth Fund International Health Policy survey data to compare how adults in the United States perceive care coordination and potential risk factors that lead to coordination gaps against 10 other countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom.

The Commonwealth Fund IHP survey included responses from more than 16,000 adults. Of those, 33% of respondents experienced at least 1 care coordination gap and 5% experienced 3 or more gaps. The United States had the largest percentage of respondents with 3 or more gaps with nearly 10% of American respondents.

The authors surmised that the high rate of poor primary care coordination in the United States may imply these patients receive lower-quality care compared with patients in the other 10 nations. Previous studies have shown that the US healthcare system ranks 37th in the world and its adult mortality ranks 43rd.

Coordination issues in the United States were not related to any patient characteristics, which implies “a systemic issue in the US healthcare system is responsible for poor primary care coordination,” the authors wrote.

However, older patients in the United States generally experienced better care coordination, which may be because they are more familiar with the health system than younger patients. It is possible, the authors suggest, that the US health system is not designed to accommodate the needs of young adults with chronic conditions. And yet, more children with disabilities are surviving into adulthood, which will require greater care coordination for this age group.

“These results suggest that increased efforts to support relationships between patients and their PCPs are required and that new programs should be designed for a younger, chronically ill population to enhance care coordination,” the authors concluded.