Interactive Communication between Primary Care and Specialty Care Improves Patient Outcomes
- Interactive communications between collaborating primary care physicians (PCPs) and specialists were associated with improved patient outcomes. Interactive communication methods included: initial joint patient consultations, regular specialist attendance at primary care team meetings, telepsychiatry with primary care physicians, scheduled phone discussions, and shared electronic progress notes.
- The studies in this review all involved collaborations with psychiatrists for management of depression and other mental health disorders and with endocrinologists for management of diabetes; however, the consistency of the effects across different primary care-specialty collaborations, healthcare conditions, and study designs suggests the potential for improvement across other specialties and conditions.
- Effectiveness was enhanced by interventions to improve the quality of information exchange (e.g., needs assessment, joint care planning).
- There were no significant differences in effect sizes between studies based in integrated vs. non-integrated healthcare systems.
Poor coordination between primary and specialty care can contribute to avoidable patient morbidity and mortality. Current chronic illness care improvement initiatives, such as the patient-centered medical home, aim to improve collaboration by identifying a clinical team or practice as having support for care coordination. However, it is uncertain whether collaborative care models that enable interactive communication - timely two-way exchange of patient information between primary care and specialists - improve patient outcomes. Investigators reviewed 23 studies (including VA studies) to assess the effects of interactive communication between collaborating primary care physicians and key specialists on outcomes for patients receiving ambulatory care who also had received psychiatric, endocrine, or cancer diagnoses. The studies reviewed in this meta-analysis included: 11 randomized mental health studies, 7 non-randomized mental health studies, and 5 non-randomized diabetes studies.
- Collaborative interventions are inherently multifaceted, so investigators could not conclude that interactive communication between PCPs and specialists was effective by itself.
- Further research on how best to structure interaction between PCPs and specialists may be key to maximizing the success of integrated care models, such as the patient-centered medical home.
This study was partly funded by HSR&D. Drs. Rubenstein and Shekelle are part of HSR&D's Center for the Study of Healthcare Provider Behavior in Sepulveda, CA.
Foy R, Hempel S, Rubenstein L, Suttorp M, Seelig M, Shanman R, and Shekelle P. Meta-Analysis: Effect of Interactive Communication between Collaborating Primary Care Physicians and Specialists. Annals of Internal Medicine February 16, 2010;152(4):247-58.