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The care coordination imperative: Responding to the needs of people with chronic diseases (USA)

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posted by Research Admin on 22 February 2012

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International

Commonwealth Fund Blog, February 21, 2012

By Anne-Marie J. Audet and Shreya Patel

The changing landscape of health and disease in the 21st century calls for a concerted response from the health care delivery system. That health care consumes 17 percent of U.S. gross domestic product is alarming, but the change in Americans' health status—one of the underlying drivers of costs—is equally staggering. The increasing prevalence of chronic illness among Americans, even as life expectancy grows and the population ages, poses major challenges to the medical profession and the entire health care system.

Nearly half of all Americans live with at least one chronic condition, and care for these patients is complex, often involving a number of clinical, occupational, and social services. One study found that the typical primary care doctor has the potential to interact with as many as 229 other doctors, in 117 different practices. Another recent study found that the probability that a physician visit would result in a referral to another physician increased from 4.8 percent in 1999 to 9.3 percent in 2009, a 94 percent increase. The absolute number of ambulatory care visits that resulted in a referral more than doubled in this 10-year period.

The latest Commonwealth Fund International Survey examines care coordination, chronic care management, and patient engagement among "sicker" adults in 11 nations . Every country faces particular challenges in caring for the rising number of people with chronic conditions, hence there is a unique opportunity to share and learn from various approaches. In the US, 23 percent of respondents with chronic conditions saw four or more doctors over the last year. Medication management for such patients is particularly complicated; 46 percent of this same group said they were taking four or more prescription drugs on a regular basis.

Not surprising, given this complexity, the survey found problems with care coordination. Patients said that they often experienced problems obtaining medical records and test results, which increased with the number of doctors seen. Thirty percent of U.S. adults with chronic conditions who had four or more doctors reported a coordination problem with test or records, compared with 24 percent of those with one or two doctors.

Coordination is a multifaceted activity that requires effective participation among many different professionals, service organizations, and—of course—the patient. However, even today, the patient is often an afterthought. While there is strong evidence that a key to successful chronic care management is engaging patients in their care, only about half of those with chronic conditions in the U.S.—and in several of the other countries surveyed—say that their regular doctor always tells them about treatment options and involves them in decisions.

Many physician practices may not be set up to serve patients with chronic conditions. Physicians still function as soloists: studies have shown that only 35 percent said that improved teamwork and communication are very effective ways to improve quality of care. And physicians' views of how well they work as part of a team—in terms of communication and collaboration—are much higher than those of the nurses and other team members.

A 2009 survey found that 41 percent of U.S. physicians say their practices function without non-physician staff, such as social workers or nurse case managers, to help manage the care of their patients.

To read the full blog, go to: http://www.commonwealthfund.org/Blog/2012/Feb/Care-Coordination-Imperative.aspx