There was a smattering of good news about American primary care physicians (PCPs) in the United States in a survey published in Health Affairs that looked at PCPs in 10 countries. What grabbed the headlines last month (as well it should) was that only 1 in 4 PCPs here were prepared to care for patients with complex chronic care conditions, placing the United States well down on the list in that category.
|PCPs can handle multiple chronic conditions|
Mental health and substance abuse also seems to be a weakness, according to the Commonwealth Fund researchers who conducted the survey, noting that in Sweden and the United States, fewer than 1 in 6 reported that their practice was well prepared for dealing with patients with those problems.
The bright spots amid the gloom were that efforts to make primary care more amenable to electronic health records seem to have paid off. Compared with other countries, a larger percentage of doctors in the United States (60%, more than twice as high as the other countries studied [see below]) provide their patients with online access to view, download, or transmit information from their medical record, according to the study, which was published in December.
|PCPs provide online access|
Data were collected from 11,547 primary care physicians in Australia, Canada, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The sample sizes ranged from 503 in New Zealand to 2,905 in Sweden. The sample size for the United States was 1,001. Family physicians, internists, and pediatricians in the United States were included.
The study noted that countries in which PCPs expressed confidence in treating complex chronic conditions focus more on teamwork and give nonphysician providers much more practice leeway.
“In addition to regulatory barriers, countries with fee-for-service models have been slow to reimburse nurses at the same rate as doctors for doing the same services,” the study states.
The researchers found big differences in the proportion of PCPs that make house calls. In the United Kingdom and the Netherlands, 80% of PCPs make house calls, compared with just 6% in the United States.
The study further states that while “the vast majority of primary care doctors across countries are satisfied with their practice and income, the themes of frustration with administrative burden and insurance hassle resonate across many of the countries. This is particularly true among those with multipayer private insurance systems (Germany, the Netherlands, Switzerland, and the United States).”
They conclude that the need to improve primary care in the United States is crucial. “Among the 10 countries in this survey, the United States has the youngest population, yet it has the highest incidence of chronic disease and spends 50–150 percent more on health care per capita than the other nine countries in the survey.”