efpc 2014, 1st september continuity of care and communication among general practitioners,...
TRANSCRIPT
EFPC 2014, 1st September
Continuity of care and communication among general practitioners,
specialists and patients in Italy
Norma Sartori, Sabina De Rosis, Chiara Seghieri, Giorgio Visentin
EFPC 2014, 1st September
PATIENT’S PERSPECTIVE
• Referrals rate
• GPs vs specialists communications
• Specialists vs GPs communications
• Specialist’s choice
• Barriers to referral
EFPC 2014, 1st September
PATIENTS PERSPECTIVE
• Patients mostly see a specialist 1 or 2 times a year
• 48% of their GPs inform the spacialist about the diagnosis
• 83% of specialists send back an answer to the GPs
• GPs don’t decide who is the specialist in 54% of cases
• 80% of patients have an easy access to specialist
EFPC 2014, 1st September
DOCTORS PERSPECTIVE
• Setting• Who decide the referral /causes of referral• GPs internal relationship• Meeting with other health professional• Counselling to others professionals• Letter to specialist• Report from specialist• Time for discharge letter
EFPC 2014, 1st September
Setting
• 50 % of practices shared with others GPs
• A minority with nurses• No one with specialists• Only 28 GPs don’t have easy access to
laboratory• 30% don’t have easy access to
Radiodiagnostic• 5% are more than 20 km from hospital
EFPC 2014, 1st September
0
20
40
60
80
100
120
140
160
prefe
renc
e
dista
nce
previo
us e
xperie
nces
perfo
rman
ce e
valuat
ion
waiting
time
costs
always
sometimes
never
missing
Referral characteristic
EFPC 2014, 1st September
COMMUNICATION BETWEEN GPS AND SPECIALISTS
• Shared decision with patients• 68% of GPS don’t send a letter to the
specialist• 54% of specialist don’t write an
answer to the GPS• One third of discharge letters are
delayed more than 5 days (14/220 never arrived)
EFPC 2014, 1st September
Interprofessional meetings
0
50
100
150
200
others
GPS
nurses
private sp
ecialist
s
hospita
l specia
lists
pharmac
ists
home nurse
s
ostetri
cs
psysioterap
ist
socia
l worke
rs
dieticians
seldom/never
every 1-3 months
>1x month
Counselling from specialists
• GPs usually exchange opinions mostly with psychiatrists, radiologists and neurologist
020406080
100120140160180200
seldom/never
every 1-3 months
> 1 x month
EFPC 2014, 1st September
Conclusions
• Referral is not (only) a matter of number
• It is often a shared decision• Communication GPs <-> Specialists
is poor• Meeting only among GPs• Teamwork is poor (only halfof GPs
work in group, but with few nurses and rare meetings)
EFPC 2014, 1st September
Conclusioni
• Assenza di un team di medici che lavorano in collaborazione per gestire il paziente– Solo metà dei medici condividono lo studio con
colleghi– Solo 35 medici hanno un infermiere– Solo 15 medici hanno nello studio un infermiere
territoriale– Rarissimi incontri strutturati con infermieri
domiciliari e assistenti sociali• Assenza nel questionario di domande volte a
indagare il lavoro in team
EFPC 2014, 1st September
Conclusions
• IT is a starting point to improve the quality of Primary
Care. If you want to reach common goal you need a
stronger relationship among the health workers in
order to motivate them for a common project
• A successful teamwork need a complex educational
process in order to overcome the competition and
facilitate collaboration
EFPC 2014, 1st September
Thank you for your attention