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
Referral characteristic
EFPC 2014, 1st September
co
st
s
tim
e
wa
itin
g
ev
al
ua
tio
n
an
ce
nc
es
fo
rm
pe
r
pr
e
vio
us
ex
pe
rie
ta
nc
e
always
sometimes
never
missing
di
s
pr
e
fe
re
nc
e
160
140
120
100
80
60
40
20
0
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
er
sG
pr
PS
iva
n
ho te ur
sp sp se
ita ec s
l s iali
pe st
ph cial s
ar ist
ho ma s
m cis
e ts
nu
rs
o
ps st es
ys etr
i
so ote ics
cia ra
l w pis
or t
di ker
et s
ici
an
s
ot
h
Interprofessional meetings
200
150
100
seldom/never
50
every 1-3 months
0
>1x month
EFPC 2014, 1st September
Counselling from specialists
• GPs usually exchange opinions mostly with
psychiatrists, radiologists and neurologist
200
180
160
140
120
100
80
60
40
20
0
seldom/never
every 1-3 months
pe
in
di
a
tri
c ia
n
t
gy ern
ne
i
co st
lo
gis
su t
r
ne geo
ur
n
o
d e lo
rm gis
at t
o
ge log
ria o
t
ps ricia
yc
hi n
a
ra tris
di
ol t
og
is t
> 1 x month
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
EFPC 2014, 1st September