Patients\u2019 perception of communication at the interface between primary and secondary care: a cross-sectional survey in 34 countries

Giacomo Scaioli,Wienke G. W. Boerma,Willemijn L. A. Schäfer,Peter Spreeuwenberg,Peter P. Groenewegen,Michael van den Berg,François G. Schellevis

doi:10.1186/s12913-019-4848-9

Abstract

BackgroundPoor communication between general practitioners (GPs) and medical specialists can lead to poorer quality, and continuity, of care. Our study aims to assess patients’ perceptions of communication at the interface between primary and secondary care in 34 countries. It will analyse, too, whether this communication is associated with the organisation of primary care within a country, and with the characteristics of GPs and their patients.MethodsWe conducted a cross-sectional survey among patients in 34 countries. Following a GP consultation, patients were asked two questions. Did they take to understand that their GP had informed medical specialists about their illness upon referral? And, secondly, did their GP know the results of the treatment by a medical specialist? We used multi-response logistic multilevel models to investigate the association of factors related to primary care, the GP, and the patient, with the patients’ perceptions of communication at the interface between primary and secondary care.ResultsIn total, 61,931 patients completed the questionnaire. We found large differences between countries, in both the patients’ perceptions of information shared by GPs with medical specialists, and the patients’ perceptions of the GPs’ awareness of the results of treatment by medical specialists. Patients whose GPs stated that they ‘seldom or never’ send referral letters, also less frequently perceived that their GP communicated with their medical specialists about their illness. Patients with GPs indicating they ‘seldom or never’ receive feedback from medical specialists, indicated less frequently that their GP would know the results of treatment by a medical specialist. Moreover, patients with a personal doctor perceived higher rates of communication in both directions at the interface between primary and secondary care.ConclusionGenerally, patients perceive there to be high rates of communication at the interface between primary and secondary care, but there are large differences between countries. Policies aimed at stimulating personal doctor arrangements could, potentially, enhance the continuity of care between primary and secondary care.

Highlights

Poor communication between general practitioners (GPs) and medical specialists can lead to poorer quality, and continuity, of care
– ‘When I am referred, my GP informs the medical specialist about my illness’;
Statistical analysis The distributions of answers to the two outcome statements: ‘When I am referred, my GP informs the medical specialist about my illness’, and: ‘After treatment by a medical specialist, my GP knows the results’, were calculated for each country

Summary

Introduction

Poor communication between general practitioners (GPs) and medical specialists can lead to poorer quality, and continuity, of care. Visits to multiple providers can result in the fragmentation of the patient’s care and the physician’s loss of important patient information Such loss of information can lead to delayed diagnoses, unnecessary repeated diagnostic examinations, and increased rates of adverse events [2,3,4,5,6,7]. It is important, in order to avoid this, that GPs and medical specialists communicate properly with their patients with regard to personal continuity of care. Communication between general practitioners and medical specialists in the referral process: a cross sectional survey in 34 countries, submitted)

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