Primary care physician attitudes regarding communication with hospitalists

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Abstract

Hospitalist systems create discontinuity of care. Enhanced communication between the hospitalist and primary care physician (PCP) could mitigate the harms of discontinuity. We conducted a mailed survey of 4,155 physician members of the California Academy of Family Physicians to determine their preferences for and satisfaction with communication with hospitalists. We received 1,030 completed surveys (26%). PCPs overwhelmingly stated that they “very much prefer” to communicate with hospitalists by telephone (77%), at admission (73%), and discharge (78%). Only discharge medications (94%) and discharge diagnosis (90%) were deemed “very important” by >90% of PCPs. Of the 556 respondents (54%) who had ever used a hospitalist, 56% were very or somewhat satisfied with communication with hospitalists, and 68% agreed that hospitalists are a good idea. Regarding communication at discharge, only 33% of PCPs reported that discharge summaries always or usually arrive before the patient is seen for follow-up. Only 56% of PCPs in our survey were satisfied with communication with hospitalists. Hospitalists should communicate with PCPs in a timely manner by telephone, at least at admission and discharge, and provide the specific pieces of information deemed important by the vast majority of PCPs. Hospitalists should also ensure that discharge information arrives in time to assist the PCP in reassuming care of their patients. It may be possible to tailor communication to individual PCPs. Further research could assess the impact of such communication on patient satisfaction and outcomes.

Section snippets

Subjects

We surveyed all physician members of the California Academy of Family Physicians (CAFP), because family physicians provide substantial amounts of primary care and are likely to consider using hospitalists, and because the CAFP endorsed the study. We excluded physicians who provide no patient care.

Survey

Our survey comprised 2 parts. The first assessed physician preferences for communication about their patients admitted to another physician’s care. To assess preferences for timing, frequency, and

Physician characteristics

Of 4,155 surveys mailed, 147 were undeliverable, resulting in 4,008 eligible subjects. We received 1,237 (31%) responses, of which 207 were blank and likely represent physicians no longer in practice or unfamiliar with hospitalists. Thus, we analyzed 1,030 usable responses (26%).

Respondents were predominantly middle-aged men (Table 1). These physicians have large patient panels and spend a full workweek seeing patients; they also spend significant time in administration, teaching, and

Discussion

When their patients are admitted to the care of another physician, PCPs prefer telephone communication, at admission and discharge, containing specific information regarding the hospitalization. Furthermore, most PCPs in our sample had experience with hospitalists and most thought hospitalists were a good idea. Although only slightly more than half of these PCPs were satisfied with their communication with hospitalists, a minority of PCPs typically contact their patients admitted to

Conclusion

We found that only 56% of PCPs are satisfied with communication with hospitalists and that communication about discharge is often delayed. In addition, PCPs vary in their desire for information about and involvement in decision making for their patients cared for by hospitalists. Increased PCP-patient contact and improved PCP-hospitalist communication may mitigate the potential harms of discontinuity. To start, hospitalists should telephone PCPs at admission and discharge and limit the

Acknowledgements

We wish to thank Jim McDonnell and Steve Tolle for their assistance with the survey. We also wish to thank Laura Johnson-Morash at the California Academy of Family Physicians (CAFP) for her assistance. Finally, we are grateful to the CAFP for endorsing this study; Paulette Adams, MD, at CAFP who signed letters to her members; and the many physicians who participated in this survey.

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Dr. Pantilat is a Soros Foundation Project on Death in America Faculty Scholar and a recipient of a Mentored Patient Oriented Clinical Research Career Development Award from the National Institutes on Aging. A grant from Pfizer supported the administration of this survey.

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