embargoed until 4:00 p.m. et, dec 7, 2015 robin osborn vice … · the commonwealth fund 2015...
TRANSCRIPT
The Commonwealth Fund2015 International Health Policy Survey of
Primary Care Physicians in 10 Countries
EMBARGOED UNTIL 4:00 P.M. ET, DEC 7, 2015
Robin OsbornVice President
Teleconference Chart Pack
R. Osborn, D. Moulds, E. Schneider, M.M. Doty, D. Squires, D. Sarnak,
“Primary Care Physicians In Ten Countries Report Challenges Caring For
Patients With Complex Health Needs,” Health Affairs, December 8, 2015.
Overview of Findings• Sample: 11,547 primary care physicians surveyed in Australia, Canada, Germany,
Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom, and
United States
Key US findings:
• Many US primary care practices report that they are not well prepared to manage
patients with complex needs
• US ranks last on primary care practice capacity to provide care after-hours
(evenings, weekends, and holidays)
• US shows significant progress on electronic medical record adoption and ranks first
for primary care practices giving patients electronic access to information from their
medical record
• US primary care doctors report significant gaps in information flow and care
coordination with specialists, hospitals, home care, and community social services
providers
• More than one-half of US doctors say time spent on insurance issues is a major
problem
• US doctors are least likely to say health system works well
2
Multiple
Chronic
Conditions
Palliative
Care
Dementia Long-Term
Home Care
Services
Social Services
in the
Community
Severe Mental
Health
Problems
Substance
Use-Related
Issues
AUS
CAN
GER
NETH
NZ
NOR
SWE
SWIZ
UK
US
Doctors’ Views of Practice Preparedness to ManagePatients with Complex Needs
3
Base: Excludes doctors who report that they "never“ see these patients.
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
>75% of doctors reporting “well-prepared” >25% and ≤ 75% of doctors reporting “well-prepared” ≤ 25% of doctors reporting “well-prepared”
Top 2 countries in each category
Practice Has Arrangement for Patients’ After-Hours Care to See Doctor or Nurse
4
94 9289
8580 78
7569
48
39
0
20
40
60
80
100
NETH NZ UK GER NOR AUS SWE SWIZ CAN US
Percent
* In Norway, respondents were asked whether the practice has arrangements or if there are regional arrangements.
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Primary Care Practice Provides Patient with Electronic Access5
Percent reporting
their practice offers
patients the option
to:
AUS CAN GER NETH NZ NOR SWE SWIZ UK US
E-mail about
medical question or
concern
30 15 50 57 53 32 61 80 38 57
View online,
download, or
transmit information
from their medical
record
11 7 8 13 24 3 20 11 28 60
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Primary Care Doctors’ Communication with Emergency Department and Hospital
6
59
43
32
26 2523 21
1614
4
0
20
40
60
80
NETH NZ UK US NOR CAN SWIZ GER AUS SWE
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Percent who report they always receive notification
when patient is seen in the ED and discharged from the hospital:
Practice Routinely Communicates with Home Care Providers About Patients’ Needs and Services
7
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
6356 55 53 52 51
34 3229 28
0
20
40
60
80
100
NOR NETH SWIZ SWE US GER UK CAN AUS NZ
Base: Excludes those who responded “not applicable.”
Percent
Doctors’ Use of Electronic Medical Records, 2006-20158
Source: 2006-2015 Commonwealth Fund International Health Policy Survey of Primary Care
Physicians.
Percent
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2006 2009 2012 2015
NZ (100%)
NOR (99%)
SWE (99%)
NETH (98%)
UK (98%)
AUS (92%)
GER (84%)
US (84%)
CAN (73%)
SWIZ (54%)
Overall Views of Health Care SystemAmong Primary Care Physicians, 2015
16
19
22
27
36
48
50
54
57
67
69
70
72
61
61
49
46
44
42
31
14
11
6
12
3
2
2
2
1
1
0% 20% 40% 60% 80% 100%
US
SWE
UK
GER
CAN
AUS
NETH
SWIZ
NZ
NOR
Works well, only minor changes Fundamental changes Completely rebuild
Percent
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. .
9
Time Practice Spends on Insurance Issues or Claiming Payments is a MAJOR Problem
10
9
20 20 21 2127
50 52 5460
0
20
40
60
80
100
NOR CAN NZ AUS UK SWE SWIZ GER US NETH
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Percent reporting time spent on administrative issues/claiming payments is a
MAJOR problem:
How Stressful is Your Job as Primary Care Physician?11
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
1724
18 18 19 1712 12
6 5
6455
58 56 5352
44 42
37 36
18 21 24 24 27 31
43 4556 59
0
20
40
60
80
100
NETH AUS NZ NOR CAN SWIZ US GER SWE UK
Not too/Not at all Stressful Somewhat Stressful Extremely/Very Stressful
• Managing complex patients requires re-thinking primary care, including:
– Multidisciplinary teams and case managers
– Email access and after-hours care
– Home visits
• Policies and payment incentives need to be aligned to encourage care coordination and delivery system integration
• In addition to adoption of electronic medical records, greater interoperability and use of clinical decision support is needed
• It’s important for policymakers to hear from doctors on the frontlines
• As the Affordable Care Act gains further traction, the reforms underway—coverage expansion, additional support for primary care, medical homes, value-based purchasing—have the potential to be transformative
• But, re-designing delivery systems to better care for patients with complex conditions will need continuous iteration and evaluation to understand what works best
• Looking to other countries offers an opportunity for valuable cross-national lessons to be learned
12
Take-Away Messages12
Country Partners and Co-funders:
• Australia: New South Wales (Bureau of Health Information)
• Canada: Canadian Institute for Health Information, Health Quality Ontario, Canadian Institutes
of Health Research, Quebec Health Commission, Canada Health Infoway
• France: Haute Authorité de Santé (HAS), Caisse Nationale de l’Assurance Maladie des
Travailleurs Salariés (CNAMTS)
• Germany: Federal Ministry of Health, BQS Institute for Quality and Patient Safety
• Netherlands: Dutch Ministry of Health, Welfare and Sport, and Scientific Institute for Quality of
Healthcare, Radboud University Nijmegen
• Norway: Norwegian Knowledge Centre for the Health Services
• Sweden: Swedish Ministry of Health and Social Affairs, The Swedish Agency for Health and
Care Services Analysis (Vårdanalys)
• Switzerland: Federal Office of Public Health
• United Kingdom: The Health Foundation
With appreciation to Dana Sarnak, David Squires, Michelle Doty, Eric Schneider,
Donald Moulds, David Blumenthal, SSRS, and country partners for their
contributions to the design of the survey, the content, and this presentation.
13
Doctors’ Views on Whether Their Practice is Well Prepared to Manage Care of Patients with Complex Needs
14
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Base: Excludes doctors who report that they "never" see these patients.
Country
Multiple
chronic
conditions
(%)
Palliative
care
(%)
Dementia
(%)
Long-term
home care
services
(%)
Social services
in the
community
(%)
Severe
mental
health
problems
(%)
Substance
use-related
issues
(%)
AUS 85 48 46 47 41 34 19
CAN 70 42 42 40 28 24 15
GER 88 58 67 68 71 32 14
NET 88 92 65 80 25 44 16
NZ 81 62 41 54 48 24 20
NOR 86 54 69 78 41 56 36
SWE 66 25 57 51 45 14 6
SWIZ 80 48 49 64 55 26 25
UK 79 81 64 60 44 43 41
US 76 41 47 46 32 16 16
2015 Commonwealth Fund International Health Policy Survey15
Methodology
• 18th survey in the International Health Policy Series
• Nationally representative random samples of primary care doctors
• Primary care doctors include general practice or family physicians in all countries, as
well as internists and pediatricians in the United States, Germany, and Switzerland.
• Views and experiences of primary care doctors in 10 countries
• Samples: Australia (747), Canada (2,284), Germany (559), Netherlands (618), New Zealand
(503), Norway (864), Sweden (2,905), Switzerland (1,065), United Kingdom (1001), and
United States (1,001)
• The survey was conducted by SSRS and country contractors
• Survey in the field March to June 2015 (plus France – September to November 2015)
• Data collection varied by country and included telephone, on-line and mail surveys.
• Response rates ranged from 19 percent in Germany to 47 percent in Sweden