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Information exchange among physicians caring for the same patient in the community

From the Ottawa Health Research Institute (van Walraven, Taljaard, Stiell, Forster); the Departments of Medicine (van Walraven, Taljaard, Forster) and Emergency Medicine (Stiell), University of Ottawa, Ottawa, Ont.; the Institute for Clinical Evaluative Sciences (van Walraven); the Department of Health Policy Management and Evaluation (Bell), University of Toronto; the Department of Medicine (Bell) and the Keenan Research Centre, Li Ka Shing Knowledge Institute (Bell), St. Michael's Hospital; Department of Medicine, Sunnybrook Health Sciences Centre (Etchells), Toronto, Ont.; and the Department of Medicine, Foothills Medical Centre (Zarnke), Calgary, Alta.

Correspondence to: Dr. Carl van Walraven, Clinical Epidemiology Program, Ottawa Health Research Institute, ASB1-003, Ottawa Hospital, Civic Campus, 1053 Carling Ave., Ottawa ON K1Y 4E9; fax 613 761-5355; carlv{at}ohri.ca

Background: The exchange of information is an integral component of continuity of health care and may limit or prevent costly duplication of tests and treatments. This study determined the probability that patient information from previous visits with other physicians was available for a current physician visit.

Methods: We conducted a multicentre prospective cohort study including patients discharged from the medical or surgical services of 11 community and academic hospitals in Ontario. Patients included in the study saw at least 2 different physicians during the 6 months after discharge. The primary outcome was whether information from a previous visit with another physician was available at the current visit. We determined the availability of previous information using surveys of or interviews with the physicians seen during current visits.

Results: A total of 3250 patients, with a total of 39 469 previous–current visit combinations, met the inclusion criteria. Overall, information about the previous visit was available 22.0% of the time. Information was more likely to be available if the current doctor was a family physician (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.54–1.98) or a physician who had treated the patient before the hospital admission (OR 1.33, 95% CI 1.21–1.46). Conversely, information was less likely to be available if the previous doctor was a family physician (OR 0.38, 95% CI 0.32–0.44) or a physician who had treated the patient before the admission (OR 0.72, 95% CI 0.60–0.86). The strongest predictor of information exchange was the current physician having previously received information about the patient from the previous physician (OR 7.72, 95% CI 6.92–8.63).

Interpretation: Health care information is often not shared among multiple physicians treating the same patient. This situation would be improved if information from family physicians and patients' regular physicians was more systematically available to other physicians.

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				H. K. Brown BA Information exchange between provider and patient Can. Med. Assoc. J., January 20, 2009; 180(2): 207 - 207. [Full Text] [PDF]

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