Why Can’t Physicians Alone Complete the Care Loop Every Time?

Paul Grundy MD, MPH, FACOEM, FACPM
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There are many misconceptions associated with the kind of tasks a primary care physician (PCP) performs on a daily basis. Some people believe that they only take care of basic care interventions such as treating sore throats, stomach infections, and fever, something that is far from the truth.

A PCP caters to hundreds of patients with hundreds of different medical conditions, something that requires in-depth knowledge and awareness.

In most European countries as well as in Canada, almost half of the physicians provide primary care services, something that our country so dearly lacks. While more than half of the patient visits are made to PCPs each year, only 35% of physicians in the US practice primary care. 

This is a grave concern. We have a higher rate of avoidable admissions as compared to similar countries. Additionally, in comparable countries, patients have quicker access to a care provider when in need. In fact, this list doesn’t end here. The use of ED facilities in place of regular doctors is also more common in the US.

What constitutes a successful primary care facility?

It is important to know a patient inside-out to maximize the care experience. This requires contextual information into their clinical and non-clinical background and dedicated care personnel to make informed decisions at a primary care level. 

A solid data foundation is paramount to maximize the efficiency of a primary care facility. The Patient-Centered Medical Home (PCMH) model has been successful in this regard for the last several years. They thrive on a centralized primary care delivery model that facilitates a strong alliance between PCPs, their patients, and patients’ families through meaningful use of healthcare technology and other resources. 

Healthcare leaders should look towards empowering their PCPs with the right support to coordinate care, manage patient populations, and enable patient engagement at each junction of care delivery.

Patients are now rarely looked upon by only a single individual. Since they have diverse needs, various healthcare stakeholders come together to provide a care experience par excellence. Such teams consist of nurse practitioners, physician assistants, specialists, administrators, and other care delivery stakeholders. One critical aspect of such a care team is its emphasis on delivering patient-centric care with much more efficiency and cost-effectiveness.

In some ways, it can be assumed that a PCP is as efficient as their team. If they do not have someone to cater to their administrative tasks, for instance, it can get extremely tough for them to devote ample time to their patients. To address such needs, a team-based approach to care delivery is gaining a lot of traction in healthcare circles.

What are the key benefits of a team-based approach?

The American Academy of Family Physicians “encourages health professionals to work together as multidisciplinary, integrated teams in the best interest of patients,” thus enabling evidence-driven, accessible care. 

There are various benefits of adopting a team-based approach to care delivery at a primary care level, including but not limited to:

  • Optimized patient experience and care outcomes

The more time providers get to spend with their patients, the more likely patients are to express themselves more candidly each time they see their physician. This, in turn, doubles up to better face-to-face interaction and more personalized care delivery. A team-based approach allows providers to focus only on the clinical aspect and frees them from other tasks that do not involve imparting care, thus enhancing care outcomes substantially.

  • Enhanced provider satisfaction

On a personal note, I am yet to meet a physician who got into medicine for any reason other than the sheer pleasure of delivering care to the needy. When they are caught in an inescapable circle of filling out datasheets and calling patients, they tend to get a little frustrated. With people at their disposal, providers can do what they wanted to do ever since their medical school days. Patient and provider engagement is not independent of one another. Happier providers often equal happier patients. 

  • Utilization optimization and cost-effective care

A team-based approach allows primary care teams to pay individual attention to each patient. With dedicated resources for following up on patients, such an approach eliminates the chances of missed appointments. Further, with everyone from an RN to a pharmacist aligned towards a common goal, the patient can traverse seamlessly across the care continuum. With everything available at a primary care level, the probability of unexpected care episodes or unattended care needs is decreased, thus optimizing overall costs while reducing visits to facilities such as EDs and SNFs.

The stairway to an efficient healthcare system goes through efficient primary care facilities

Healthcare stakeholders have long pressed for the need of having a team-based approach to care delivery. In fact, care teams often believe that they are working as a team, but physicians still end up typing those long emails and following up on patients they referred to another physician.

A team-based approach allows care teams to ideate new ways to bring patients closer to the care loop, invest their free time in discussing innovations, and increase the sheer amount of patients that they can see each day.

The essence here is to understand that focusing on primary care facilities does not mean focusing less on the specialties. In fact, the US arguably has one of the most advanced specialty care systems in the world, and we should all be proud of what we have been able to achieve in this context. The intent should, however, be to reduce the burden off of their shoulders and kill the epidemic of unnecessary utilization and sub-standard outcomes that have become a part of our healthcare system.

A little push in this direction can go a long way in building the healthcare system that we all aspire to be a part of each day!

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