Decades after hospitalists took over inpatient care in the 1990s, hospitalists and primary care physicians (PCPs) still struggle with a communication gap, university hospital researchers have found. .
Hospitalists and PCPs want more dialogue while patients are in hospital to coordinate and personalize care, according to data collected at Beth Israel Deaconess Medical Center, Boston, Massachusetts. The findings were presented today at the Society of General Internal Medicine’s 2022 annual meeting in Orlando, Florida.
“I think one of the main takeaways is that hospitalists and primary care physicians agree that it’s important for primary care physicians to be involved in a patient’s hospitalization. They both identified a value that PCPs can bring to the table,” co-investigator Kristen Flint, MD, a primary care resident, said. Medscape Medical News.
A majority in both camps said communication with the other party happened less than 25% of the time, when ideally it would happen half the time. Flint noted that communication tools differ from hospital to hospital, which limits the applicability of the findings.
The research team interviewed 39 hospitalists and 28 PCPs employed by the medical center during the first half of 2021. They also interviewed six hospitalists during patient admission and discharge.
The hospitalist movement, which arose in response to the cost and efficiency demands of managed care, led to the start-up of inpatient specialists, reducing the need for PCPs to commute between their offices and the hospital to care for patients in both settings.
Primary care involvement is important during hospitalization
In the Beth Israel Deaconess survey, 4 out of 5 hospitalists and three quarters of PCPs agreed that participation in primary care is still important during hospitalization, especially during discharge and admission. Hospitalists have reported that PCPs provide valuable data about a patient’s health status, social supports, mental health, and goals of care. They also said that having such data helps build patient confidence and improve the quality of hospital care.
“Most of the projects around communication between inpatient and outpatient physicians have really focused on the moment of discharge,” when clinicians identify what care a patient will need after leaving the hospital, Flint said. “But we found that both parties felt that increased communication at intake would also be beneficial.”
The biggest barrier for PCPs, cited by 82% of respondents, was lack of time. The main obstacle for hospitalists was the inability to find contact information for the other party, which was cited by 79% of survey participants.
Hospitalists operate “in a very stressful environment”
Beth Israel Deaconess’ research “documents what has been widely suspected,” said primary care general internist Allan Goroll, MD.
Goroll, a professor of medicine at Harvard Medical School, Boston, Massachusetts, told Medscape that hospitalists operate “in a very stressful environment.”
“They [hospitalists] appreciate accurate information about a patient’s recent medical history, test results, and responses to treatment, as well as a briefing about the patient’s values and preferences, family dynamics, and admission priorities. This allows for safer, more personalized and more efficient hospital admission,” said Goroll, who was not involved in the research.
In a 2015 article in The New England Journal of Medicine, Goroll and Daniel Hunt, MD, director of hospital medicine at Emory School of Medicine, Atlanta, Georgia, proposed a collaborative model in which PCPs visit hospitalized patients and serve as consultants to hospitalized patient staff. Goroll said Massachusetts General Hospital in Boston, where he practices, initiated a study of this approach, but it was halted by the pandemic.
“As limited time is the most commonly cited barrier to communication, future interventions such as asynchronous forms of communication between the two groups should be considered,” the researchers wrote in the NEJM Perspective.
To bridge the gap, Beth Israel Deaconess will explore converting an admission notification letter sent to PCPs into a two-way communication tool into which PCPs can insert patient information, Flint said.
Flint and Goroll did not disclose any relevant financial relationship.
2022 Annual Meeting of the Society of General Internal Medicine: abstract PS3-26. Presented April 7, 2022.
Mary Chris Jaklevic is a medical journalist in the Midwest.