Communication gaps remain open between primary care physicians, specialists

Communication gaps remain open between primary care physicians and specialists who share patients, despite potential connections through improved electronic health records (EHR).

Lack of communication could affect a large number of patients across the country, according to a new study that examined connections between primary care physicians (PCPs) and specialists. “Communication Gaps Persist Between Primary Care and Specialist Physicians” was published in the Annals of Family Medicine.

A 2008 study “found sizeable gaps in communication among physicians caring for mutual patients,” with potential effects on patients, such as delayed diagnoses, unnecessary testing, and patient and physician dissatisfaction. With widespread use of EHR, it appeared physician communication might have improved since then, but things weren’t much better in 2019. Researchers examined responses from 4,754 PCPs who used the Comprehensive Primary Care Plus (CPC+) payment model through the federal Centers for Medicare & Medicaid Services, along with other data such as Medicare claims and enrollment.

The survey asked two questions:

• “When you refer a patient to a specialist, how often do you send the specialist notification of the patient’s history and reason for the consultation?”
• “How often to you receive useful information about your referred patients from specialist?”

Reply options were, “Always or most of the time,” “Sometimes,” and “Seldom or never.”

A total of 22% of PCPs reported they “sometimes” or “seldom or never” sent clinical information to specialists at the time of referral, and up to 35% reported they “sometimes” or “seldom or never” received information back from specialists after consultations, the study said. Physicians participating in the CPC+ survey were highly motivated with sophisticated EHR use, so “actual communication behaviors nationwide are likely worse than what we found,” the study said.

“Because these are physician-level proportions, the number of patients who are potentially affected is large,” the study said. “Further, the presence of any communication between providers does not guarantee that practitioners are sending or receiving the optimal information needed for clinical decision making.”

More communication measurement is needed because it is not enough to assume EHR systems will improve connections between physicians, the study said.