Minding the Gap: Factors Associated With Primary Care Coordination of Adults in 11 Countries

Jonathan Penm; Neil J. MacKinnon; Stephen M. Strakowski; Jun Ying; Michelle M. Doty

doi:10.1370/afm.2028

Article Figures & Data

Figures

Tables
Additional Files

Download figure
Open in new tab
Download powerpoint
Figure 1
Percentage of respondents with care coordination gaps by country.
^aPoor primary care coordination was defined as having at least 3 gaps out of a possible 5.

View popup

Table 1

Distribution of Respondents by Country, Socioeconomic Demographics, and Health-Related Characteristics^a

Characteristic	All Respondents, No. (%) (N = 13,958)	Respondents With Poor Primary Care Coordination, No. (%)^b
Characteristic	All Respondents, No. (%) (N = 13,958)	All Countries (n = 724)	United States (n = 137)
Country
Australia	1,623 (11.6)	68 (9.4)	NA
Canada	3,787 (27.1)	174 (24.0)	NA
France	984 (7.0)	61 (8.4)	NA
Germany	777 (5.6)	60 (8.3)	NA
Netherlands	774 (5.5)	18 (2.5)	NA
New Zealand	715 (5.1)	27 (3.7)	NA
Norway	683 (4.9)	33 (4.6)	NA
Sweden	1,215 (8.7)	57 (7.9)	NA
Switzerland	1,229 (8.8)	71 (9.8)	NA
United Kingdom	776 (5.6)	18 (2.5)	NA
United States	1,395 (10.0)	137 (18.9)	137 (100.0)
Age-group, y
18–24	1,123 (8.0)	48 (6.6)	7 (5.1)
25–34	1,735 (12.4)	84 (11.6)	19 (13.9)
35–49	3,339 (23.9)	202 (27.9)	33 (24.1)
50–64	4,107 (29.4)	231 (31.9)	45 (32.8)
≥65	3,654 (26.2)	159 (22.0)	33 (24.1)
Regular doctor often/always:
Knows your medical history	11,332 (81.2)	488 (67.4)	93 (67.9)
Spends enough time with you	11,338 (81.2)	473 (65.3)	83 (60.6)
Involves you as much as you want	11,355 (81.4)	494 (68.2)	91 (66.4)
Explains things well	12,165 (87.2)	511 (70.6)	86 (62.8)
Insurance – US respondents only	(n = 1,395)	(n = 137)
No insurance	141 (10.1)	14 (10.2)	14 (10.2)
Private	634 (45.4)	57 (41.6)	57 (41.6)
Medicare	433 (31.0)	32 (23.4)	32 (23.4)
Medicaid	180 (12.9)	34 (24.8)	34 (24.8)
Missing	7 (0.5)	0 (0.0)	0 (0.0)

NA = not applicable.
↵a Full results are available online (Supplemental Appendix 2, available at http://www.AnnFamMed.org/ content/15/2/113/suppl/DC1/).
↵b Poor primary care coordination was defined as having at least 3 gaps out of a possible 5.

View popup

Table 2

Odds Ratios for Poor Primary Care Coordination and Individual Care Coordination Gaps^a

Characteristic	Poor Primary Care Coordination, Odds Ratio (95% CI)^b	Care Coordination Gap, Odds Ratio (95% CI)^c
Characteristic	Poor Primary Care Coordination, Odds Ratio (95% CI)^b	Test/Records Not Available	Conflicting Information	Unnecessary Test Ordered	Specialist Not Informed	PCP Not Informed
Country
Australia	0.5 (0.4–0.7)^d	0.5 (0.4–0.6)^d	0.9 (0.7–1.1)	0.6 (0.5–0.7)^d	0.6 (0.5–0.8)^d	0.6 (0.5–0.8)^d
Canada	0.5 (0.4–0.6)^d	0.6 (0.5–0.8)^d	0.7 (0.6–0.9)^d	0.4 (0.3–0.5)^d	0.8 (0.6–1.0)	0.9 (0.7–1.1)
France	0.6 (0.4–0.8)^d	0.6 (0.4–0.7)^d	0.7 (0.5–0.8)^d	0.8 (0.6–1.0)	0.9 (0.7–1.2)	1.2 (1.0–1.5)
Germany	0.5 (0.4–0.8)^d	0.4 (0.3–0.5)^d	0.9 (0.7–1.2)	1.0 (0.8–1.3)	1.0 (0.8–1.4)	2.6 (2.0–3.3)^d
Netherlands	0.3 (0.2–0.5)^d	0.8 (0.6–1.1)	1.6 (1.2–2.0)^d	1.3 (1.0–1.7)	0.4 (0.2–0.5)^d	0.3 (0.2–0.4)^d
New Zealand	0.5 (0.3–0.8)^d	0.5 (0.4–0.7)^d	1.0 (0.8–1.3)	0.5 (0.3–0.6)^d	0.6 (0.4–0.8)^d	0.7 (0.5–1.0)
Norway	0.5 (0.3–0.7)^d	0.3 (0.3–0.5)^d	0.9 (0.7–1.2)	0.5 (0.4–0.7)^d	0.7 (0.5–1.0)	1.3 (1.0–1.6)
Sweden	0.5 (0.3–0.6)^d	0.6 (0.5–0.7)^d	0.8 (0.6–1.0)	0.2 (0.2–0.3)^d	0.8 (0.7–1.1)	1.3 (1.0–1.6)
Switzerland	0.8 (0.6–1.1)	0.6 (0.5–0.8)^d	0.8 (0.6–1.0)	1.7 (1.3–2.1)^d	1.3 (1.0–1.7)	0.9 (0.7–1.1)
United Kingdom	0.3 (0.2–0.5)^d	0.5 (0.4–0.7)^d	0.4 (0.3–0.5)^d	0.5 (0.3–0.7)^d	0.6 (0.4–1.0)	0.5 (0.3–0.7)^d
United States	Reference	Reference	Reference	Reference	Reference	Reference
Age-group, y
18–24	1.9 (1.4–2.7)^d	1.9 (1.5–2.4)^d	3.1 (2.5–3.8)^d	2.4 (1.8–3.0)^d	1.1 (0.8–1.4)	1.3 (1.0–1.5)
25–34	2.3 (1.7–3.0)^d	2.2 (1.8–2.8)^d	3.0 (2.4–3.6)^d	2.0 (1.6–2.5)^d	1.3 (1.0–1.6)	1.2 (1.0–1.5)
35–49	2.2 (1.7–2.7)^d	2.3 (1.9–2.8)^d	2.6 (2.2–3.1)^d	1.9 (1.6–2.3)^d	1.2 (1.0–1.4)	1.2 (1.1–1.5)^d
50–64	1.6 (1.2–2.0)^d	1.9 (1.6–2.3)^d	1.8 (1.6–2.1)^d	1.5 (1.3–1.8)^d	1.2 (1.0–1.4)	1.0 (0.9–1.2)
≥65	Reference	Reference	Reference	Reference	Reference	Reference
Regular doctor knows your medical history
Often or always	0.6 (0.5–0.7)^d	0.7 (0.6–0.8)^d	0.7 (0.6–0.8)^d	0.6 (0.5–0.7)^d	0.8 (0.7–0.9)^d	0.8 (0.7–0.9)^d
Never, rarely, or sometimes	Reference	Reference	Reference	Reference	Reference	Reference
Regular doctor spends enough time with you
Often or always	0.6 (0.5–0.8)^d	0.7 (0.6–0.8)^d	0.6 (0.5–0.6)^d	0.7 (0.6–0.8)^d	0.8 (0.7–0.9)^d	0.8 (0.7–0.9)^d
Never, rarely, or sometimes	Reference	Reference	Reference	Reference	Reference	Reference
Regular doctor involves you as much as you want
Often or always	0.6 (0.5–0.8)^d	0.8 (0.6–0.9)^d	0.7 (0.6–0.8)^d	0.8 (0.6–0.9)^d	0.9 (0.7–1.1)	0.8 (0.7–0.9)^d
Never, rarely, or sometimes	Reference	Reference	Reference	Reference	Reference	Reference
Regular doctor explains things well
Often or always	0.6 (0.5–0.7)^d	0.7 (0.6–0.9)^d	0.8 (0.7–0.9)^d	0.6 (0.5–0.7)^d	0.8 (0.7–0.9)^d	0.8 (0.6–0.9)^d
Never, rarely, or sometimes	Reference	Reference	Reference	Reference	Reference	Reference

PCP = primary care physician.
↵a Parameters included in each model also included sex, household income, health status, number of doctors seen in the last year, and number of medications. Full regression analysis results are available online (Supplemental Appendix 3, available at http://www.AnnFamMed.org/content/15/2/113/suppl/DC1/).
↵b Had at least 3 gaps out of a possible 5.
↵c Gaps in detail: test/records not available at scheduled appointment; conflicting information received for medical care; unnecessary test ordered as it had already been done; specialist not informed by PCP; and PCP not informed by specialist.
↵d P <.05 after adjusting for multiple comparisons using the Bonferroni method.

Additional Files

Figures
Tables

Supplemental Appendixes 1-3

Supplemental Appendixes 1-3

Files in this Data Supplement:

Supplemental data: Appendixes 1-3 - PDF file
The Article in Brief

Minding the Gap: Perceived Factors Associated With Primary Care Coordination of Adults in 11 Countries

Jonathan Penm , and colleagues

Background Care coordination (organizing patient care activities and sharing information among participants) is a key strategy for improving the effectiveness, safety and efficiency of health care systems. This study examines care coordination in 11 high-income countries.

What This Study Found One out of every three respondents experienced at least one coordination gap in primary care, but the overall percentage reporting poor primary care coordination was low. Among the 11 countries evaluated, the United States had the highest rate of poor primary care coordination. Among patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom and the United States, the rate of poor primary care coordination was 5 percent overall and highest in the US at 10 percent. Patients were less likely to experience poor care coordination if their primary care physician knew them well, spent sufficient time with them, involved them in care, and explained things well. Poor primary care coordination was more likely to occur among patients with chronic conditions and patients younger than 65 years. In the US, patients reported similar levels of poor primary care coordination regardless of insurance status, health status, income level and sex, suggesting a systemic issue that distinguishes the efficacy of primary care coordination from that of other countries.

Implications

The authors note that care coordination gaps have been associated with a higher risk of patients experiencing a medical error, more follow-up appointments, and unnecessary health care spending. They conclude these findings warrant increased efforts to support relationships between primary care providers and patients, especially those who are younger and chronically ill.