Commonwealth Fund International Survey of Primary Care Physicians

by Clive Riddle, November 6, 2009

The Commonwealth Fund this week released their report: A Survey of Primary Care Physicians in 11 Countries, 2009: Perspectives on Care, Costs, and Experiences which compares U.S. primary care physician attributes to those in Europe, Australia, New Zealand and Canada.

Harris Interactive and subcontractors conducted the surveys via mail, phone and internet earlier this year, with results reported from over 10,000  primary care doctors, including 1,016 in in Australia, 1,401 in Canada, 502 in France, 715 in Germany, 844 in Italy, 614 in Netherlands, 500 in New Zealand, 774 in Norway, 1,450 in Sweden, 1,062 in the U.K., and 1,442 in the U.S.

The Commonwealth Fund press release on the report shaped their study in the context of health reform. Cathy Schoen, Commonwealth Fund Senior Vice President and lead author tells us "we spend far more than any of the other countries in the survey, yet a majority of U.S. primary care doctors say their patients often can’t afford care, and a wide majority of primary care physicians don’t have advanced computer systems to access patient test results, anticipate and avoid medication errors, or support care for chronically ill patients. The patient-centered chronic care model originated in the U.S., yet other countries are moving forward faster to support care teams including nurses, spending time with patients, and assuring access to after-hours. The study underscores the pressing need for national reforms to close the performance gap to improve outcomes and reduce costs." Commonwealth Fund President Karen Davis adds “access barriers, lack of information, and inadequate financial support for preventive and chronic care undermine primary care doctors' efforts to provide timely, high quality care and put the U.S. far behind what many other countries are able to achieve. Our weak primary care system puts patients at risk, and results in poorer health outcomes, and higher costs. The survey provides yet another reminder of the urgent need for reforms that make accessible, high-quality primary care a national priority."

Here’s a few highlights the Commonwealth Fund pointed out from their report:

• More than half of U.S. physicians (58%) report their patients often have difficulty paying for medications or other out-of-pocket costs, compared to between 5 percent and 37 percent in the other countries.

• Twenty-eight percent of U.S. doctors report their patients often face long waits to see a specialist—a rate similar to that reported by Australian (35%) and U.K. (22%) physicians, the lowest rates in the survey

• Just 29 percent of U.S. doctors report any arrangement for patients to see a doctor or nurse after hours, a drop from 40 percent in the 2006 Commonwealth Fund International Health Policy Survey. In contrast, nearly all doctors in the Netherlands (97%), and large majorities in New Zealand (89%) and the U.K (89%) report after-hour provision.

• While nearly half (46%) of U.S. primary care doctors report using electronic medical records (EMRs)—up from 28 percent in 2006—U.S. primary care practices, along with Canadian doctors, continue to lag well behind other leading countries.

• Primary care physicians in the U.S., are among the least likely to report that they receive financial incentives for quality improvement, such as bonuses for achieving high patient satisfaction ratings, increasing preventive care, use of teams, or managing patients with chronic disease or complex needs.

• Teams that include health professionals such as nurses serve an important role in managing care, especially for chronic conditions. The survey results indicate that use of teams including nurses and other health professionals to manage care, especially for chronic conditions,  is widespread in Sweden (98%), the U.K, (98%) and many other countries but was far less frequent in the United States (59%), Canada (52%), and France (11%)

• Asked about comparative information systems, doctors in the U.K. are most likely to routinely receive and review data on clinical outcomes (89%), followed by Sweden (71%), New Zealand (68%), and the Netherlands (65%). Less than half of doctors in other surveyed countries—including the U.S. at 43 percent—report such reviews.

• U.K physicians (65%) were by far the most likely to report they receive data on how they compare to other practices and, along with Sweden and New Zealand doctors, the most likely to have information on patient experiences. Notably, U.S. doctors lagged well behind these leading countries on feedback on both clinical quality and patient experiences.

I compiled some selected key issues addressed in the survey into a table, to make it easier to compare various primary care responses by country. While the Commonwealth Fund does go out of their way to paint the U.S, “system” in a bad light as fodder for reform, and perhaps glosses over that U.S. Access to Care isn’t comparatively that bad (refer to specialist wait times below) it is hard to argue we don’t have a lot of room for improvement across the board.

Country	(1) EHRs	(2) Patient Reminders	(3) Rx Costs	(4) Long Specialist Waits	(5) Patient Rx List	(6) Outcome Data	(7) Financial Incentives
Australia	95%	89%	23%	34%	12%	24%	65%
Canada	37%	31%	27%	75%	16%	17%	62%
France	68%	60%	17%	53%	43%	12%	50%
Germany	72%	32%	28%	66%	66%	41%	58%
Italy	94%	33%	37%	75%	59%	40%	70%
Netherlands	99%	80%	33%	36%	4%	65%	81%
New Zealand	97%	97%	25%	45%	5%	68%	80%
Norway	97%	15%	5%	55%	20%	25%	35%
Sweden	94%	51%	6%	63%	29%	71%	10%
United Kingdom	96%	97%	14%	22%	83%	89%	89%
United States	46%	47%	58%	28%	30%	43%	36%

(1) MDs using EHRs

(2) Send Patient Reminders for Preventive/Follow Up Care

(3) Patients have difficulty paying for medications

(4) Patients have long wait times to see specialists

(5) Routinely provide patients list of all medications

(6) Routinely receives/reviews patient outcome data

(7) Can receive various Financial incentives