Primary Care Research

Better communication and coordination of care could reduce frustration experienced by patients with chronic diseases

In a recent report on chronic illness in America, 45 percent of patients with a chronic illness reported they received no help from their doctor or health plan in coordinating their medical services. A new study, supported in part by the Agency for Healthcare Research and Quality (HS13008), echoes these patients' frustration. It found that patients with multiple chronic illnesses suffered more hassles during interactions with the health care system than those with one chronic illness. However, improved primary care communication and coordination reduced these hassles.

Michael L. Parchman, M.D., M.P.H., of the University of Texas Health Science Center, and colleagues analyzed responses of surveys mailed to 422 veterans with one or more chronic illnesses who were cared for in the South Texas Veteran's health care system. The patients were divided into three multiple chronic illness clusters: metabolic, obesity, and psychiatric.

They compared their scores on a 16-item scale of care hassles to those of three corresponding clusters of primary care patients with one chronic illness. Hassles ranged from lack of information about treatment options and problems getting medications refilled in time to long waits for appointments with specialty clinics/doctors and lack of information about why certain lab tests or x-rays were needed.

The researchers also asked patients about four measures of primary care: accumulated knowledge of the patient by the clinician, coordination of care, communication, and preference for first contact with their primary care clinician. After controlling for patient characteristics, primary care communication and coordination of care were inversely associated with patient hassle scores. As communication and coordination improved, the reported level of hassles decreased.

More details are in "Primary care attributes, health care system hassles, and chronic illness," by Dr. Parchman, Polly Hitchcock Noel, Ph.D., and Shuko Lee, M.S., in the November 2005 Medical Care 43(11), pp. 1123-1129.

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