Doctors favor patient-centered care but haven't adopted it fully

Physicians are pretty good at providing same-day appointments for patients who want them. And they usually receive timely test results of patients they referred to another doctor.

They don't do as well at routinely using electronic medical records or communicating with patients via e-mail.

Those conclusions are based on what 1,837 physicians, in practice at least three years, told researchers. The nationwide survey led the authors of a new study in the April 10 Archives of Internal Medicine to find that physicians favor such patient-centered care practices, but few practice all of them.

Physicians were asked about 11 patient-centered practices, such as same-day appointments, e-mail with patients, reminder notices for preventive or follow-up care, electronic medical records and patient survey feedback.

The study said that about one in four doctors uses electronic medical records and about half send reminder notices to patients about preventive or follow-up care.

Three in four primary care physicians had problems with the availability of patients records, test results or other information at the time of a scheduled visit.

But researchers found that doctors favor many elements of patient-centered care. The study said 87% of primary care physicians support improved teamwork among health care professionals while 85% of all surveyed physicians favor easy access to patients of medical records.

"They have the right attitude. They thought a team approach to care was a good thing, and they're planning to look into electronic medical records," said lead study author Anne-Marie Audet, MD, vice president for quality improvement at the Commonwealth Fund, a private foundation in New York City.

New models of care

The findings come at a time when some physician organizations are making patient-centered care a key component of efforts to redesign how physicians provide care.

The American College of Physicians in January released a paper calling for a new model of care called the advanced medical home. The model is patient-centered, and patients would have a personal physician who works with a team of health care professionals.

"We are kind of boxed in right now to a visit-centered [system], and it really does not [encourage] people to provide e-mail consultations and follow-up phone calls," said Arkansas internist William Golden, MD, chair of the ACP's Board of Regents. "People realize this [model] is a new way of doing business."

The Future of Family Medicine report, released in 2004 by national family medicine organizations, called for transforming the specialty to a new model with patient-centered care as a core element. Last month, the American Academy of Family Physicians announced that 36 practices will take part in a national demonstration project of TransforMED, an $8 million AAFP practice redesign initiative.

"Patient-centered care has not happened, mainly because of the system in which we work. But there's a recognition that for better quality of care, we've got to do this," said James C. Martin, MD, board chair of TransforMED.

American Medical Association President J. Edward Hill, MD, said the AMA supports the focus on patient-centered care practices.

"We're encouraging that type of effort, particularly among the primary care specialties. They have that long-term relationship with patients," he said.

The Archives of Internal Medicine study said physicians face challenges in implementing patient-centered care practices. It found that 63% of physicians said training and knowledge were barriers to adopting electronic medical records, and 84% cited cost as a barrier.

The study said financial incentives, technical assistance and education might encourage more physicians to adopt patient-centered practices. It also noted that some professional organizations and specialty societies are helping physicians incorporate patient-centered tools into their practice. For example, the ACP program "Closing the Gap" is a team-oriented program that trains doctors and others to use patient-centered care for patients with chronic diseases.

"We have to get the right financial incentives and the right professional incentives because it's not going to happen on its own," Dr. Audet said.