Survey: PCPs from 10 nations have drastically different take on healthcare delivery

A survey of international primary care providers (PCPs) revealed wide variations from country to country in patient access, health IT utilization, care coordination, performance feedback and providers’ perception of healthcare delivery. The results were published online Nov. 15 by Health Affairs.

“Countries differ in the role primary care has historically played in their healthcare delivery systems, including the scope of services and the use of nurses and referrals for specialized care,” Cathy Schoen, MS, senior vice president of policy research and evaluation at the Commonwealth Fund in New York City, wrote with her colleagues. “However, there has been conceptual convergence in recent years on the need to redesign primary care to meet the healthcare needs of aging populations and address the increased prevalence of chronic disease.”

To assess variations, researchers surveyed and conducted interviews with between 500 and 2,000 randomly selected primary care providers from each of the following countries: Canada, Germany, the Netherlands, Norway, the United States, New Zealand, Australia, France, Switzerland and the United Kingdom.

Patient Access

Responses indicated stark differences across countries in patients’ ability to receive timely access to healthcare and pay for healthcare.

For instance, a majority of providers from France, the Netherlands, New Zealand and Switzerland reported that their patients could get appointments within one or two days, whereas fewer than one-quarter of Canadian providers reported their patients could be seen within one or two days.

While majorities of providers from several countries indicated their patients could receive care after hours, only about one-third of U.S. providers reported making arrangements for patients to be seen after hours. Nearly 60 percent of U.S. providers also reported having patients that had difficulty paying for care, a rate well above any other other country.

Health IT

While the U.S. had lagged behind other nations in EHR implementation, a spike in the adoption rate over the past few years has U.S. providers catching up.

Approximately one-third of providers from France, Germany and the U.S. reported using EHRs. Nearly all of the respondents from Australia, the Netherlands, New Zealand, Norway and the U.K. reported using EHRs. A range of information exchange capabilities was apparent, with 14 percent of Canadian providers reporting the ability to 55 percent of providers from New Zealand.

The availability of online tools for patients varied. Approximately one-half of provider from Norway and 40 percent from the United Kingdom reported patients had the ability to request appointments online. More than one-half of providers from the Netherlands, Norway, Switzerland and the U.K. reporte patients could fill prescriptions online. Fewer than one-third of providers from all other nations reported that patients had the ability to do either.

Care coordination

Survey results revealed varying levels of communication between specialists, hospitals and primary care providers from country to country. Providers from Australia, France, Germany and the U.S. reported that they were infrequently informed when a patient was hospitalized, but nearly all providers from the Netherlands and New Zealand reported receiving this information. Few providers from any country reported that they frequently received patient information in a timely manner from specialists.

Performance Feedback

Nearly all of the providers from Germany, the Netherland and New Zealand and more than one-half from Australia, New Zealand and the U.S. reported that they received performance feedback on clinical outcomes. France had the fewest percentage of providers reporting this ability.

A majority of providers from the U.K. and New Zealand reported receiving comparative data on clinical outcomes, allowing them to compare their performance to other providers. This ability was not widely reported among providers from the other countries.

Provider perceptions of healthcare system

Providers from eight countries were significantly more pleased with their healthcare system than those in the United States and Germany, where 15 and 22 percent, respectively, reported satisfaction.

“Satisfaction with primary healthcare practice appears to be related to physicians’ perceptions of patients’ access to care,” Schoen et al wrote. “Within eight of the study countries (all but Australia and France), doctors concerned about patient access were significantly less likely to be satisfied with practicing medicine.”

“The redesign of primary care is central to reforms aimed at improving health system performance,” they concluded. “As a result, there are opportunities to learn from diverse efforts underway in the United States and other countries that are designed to achieve shared health reform goals. Listening to doctors on the front lines of primary care can help identify gaps and target reforms of health systems.”