GPs like their electronic systems but can’t share electronically: survey
Most Australian and New Zealand GPs are more than happy with their practice management systems but the majority still struggle to communicate electronically with patients and healthcare providers outside their practice, an international poll has found.
And while they believe their practices are well prepared to manage the care of patients with multiple chronic conditions, that confidence begins to decline when it comes to patients who may need more multi-disciplinary care coordination, including patients who need palliative care, who have dementia, who need long-term home care or care in the community, and those with severe mental health or substance misuse problems.
Less than half of Australian GPs believe the health care system works well and only needs minor changes, one in five find the job very or extremely stressful and just over one third are dissatisfied with their income, but only 12 per cent are somewhat or very dissatisfied with practising medicine.
The numbers are similar for New Zealand GPs, although they seem to like their PMSs less, communicate electronically with the outside world more, are much more unhappy with the time they get to spend with patients, and aren’t so bothered about their incomes.
The results come from the 18th edition of the US-based Commonwealth Fund international health policy survey of primary care physicians, which annually polls GPs in 10 countries: Australia, Canada, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.
This year, the survey assessed the experiences of primary care doctors regarding the preparedness of their practice to manage the care of patients with complex needs (both children and adults), offer patient access, communicate with other specialty and community-based providers, and use health information technology.
The survey also asked about their views of their health system and satisfaction with aspects of their practice. The results are published online in Health Affairs this week.
The survey found that the vast majority of primary care doctors in all 10 countries think their practice is well prepared to manage the care of patients with multiple chronic conditions – in Australia it is 85 per cent, for New Zealand 81 per cent.
However, that confidence begins to drop away as they are asked whether they are well prepared to manage patients requiring palliative care (48 and 62 per cent respectively), patients with dementia (46 and 41), patients needing long-term home care services (41 and 48), patients needing social services in the community (41 and 48), patients with several mental health problems (34 and 24) and patients with substance use-related issues (19 and 20).
The authors write that evidence is mounting that health IT can help improve care coordination, but while Australian GPs in particular were satisfied with their electronic medical record – 80 per cent of Australian GPs said they were satisfied or very satisfied with their EMR/PMS, compared to 69 per cent of Kiwi doctors, 52 per cent of US doctors and a very low 37 per cent of Swedish doctors – there appeared to be very little electronic communication to and from Australian general practice. New Zealand general practice fared quite a lot better.
For example, 58 per cent of Australian GPs and 69 per cent of NZ GPs always or often received timely and relevant information when one of their patients was seen by a specialist.
However, only 18 per cent of Australian GPs were always notified when patients were discharged from hospital. For Kiwi GPs, it was 56 per cent.
Likewise, only 18 per cent of Australian GPs were notified when a patient was seen in an emergency department, compared to 56 per cent of Kiwi doctors.
Both countries reported low rates of communication with home care providers about a patient’s needs and services (29 and 28 per cent respectively).
Differences between countries were quite stark when it comes to electronic sharing of information with patients. A surprisingly high 30 per cent of Australian GPs reported that patients can email them about medical questions or concerns, compared to 53 per cent of NZ GPs. Switzerland had the highest rates at 80 per cent.
But only 11 per cent of Australian GPs and 24 per cent of New Zealand GPs allowed their patients to view online, download or transmit information from their medical record. The highest rate was in the US (60 per cent), where primary care doctors have been incentivised to do so under the meaningful use provisions of the Affordable Care Act.
As the authors write, the mere fact of having an electronic medical record does not ensure electronic flow of information with doctors or patients outside of one’s practice. Australia, New Zealand, the Netherlands, Norway, Sweden and the UK have had near universal EMR/PMS adoption for some time, but there is a great deal of variation in uptake rates of more advanced electronic functionalities.
Ninety-two per cent of Australian GPs and all Kiwi GPs surveyed used an EMR/PMS, but just over half (56 and 61 per cent respectively) routinely receive computerised reminders for guideline-based intervention or screening tests and only 34 per cent of Australian GPs can electronically exchange patient clinical summaries with doctors outside the practice. New Zealand leads the pack in this category with 75 per cent able to share clinical summaries.
On some of the other measures surveyed:
- Healthcare system works well, only minor changes needed – 48% and 57%
- System has improved (over past three years) – 24% and 32%
- About the same – 58% and 52%
- Gotten worse – 18% and 16%
- Job is very or extremely stressful – 21% and 24%
- Time spent on administrative issues related to claiming payments is a major problem – 21% and 20%
- Somewhat or very dissatisfied with time spent per patient – 25% and 41%
- Somewhat or very dissatisfied with their income – 36% and 26%
- Somewhat or very dissatisfied practising medicine – 12% and 13%.
The survey included 747 Australian GPs and 503 Kiwi GPs. It was conducted between March and June this year.
“Our survey results show that information exchange in all countries is a work in progress, with issues around data decentralization, security, and privacy often creating stumbling blocks,” the authors write.
“Furthermore, while the findings show that the vast majority of primary care doctors across countries are satisfied with their practice and income, the themes of frustration with administrative burden and insurance hassle resonate across many of the countries. This is particularly true among those with multi-payer private insurance systems (Germany, the Netherlands, Switzerland, and the United States).”