BMJ  2006;333:985 (11 November), doi:10.1136/bmj.39024.460463.DB

News

UK fares well in survey of primary care, but US doesn't

¹ New York

The United Kingdom is a leader in electronic patient records and reminder systems, an international survey of about 7000 primary care doctors shows. The UK also leads in providing care by nurses or doctors outside working hours (and outside the emergency room), in taking a team approach to care of patients with multiple or chronic illnesses, and in offering doctors financial incentives to improve their quality of care, the survey, which was carried out in seven countries, found.

"The US outspends the other countries. Total per capita costs in 2003 [in the US] came to $5635 [£2950, 4400] compared to $2231 in the UK. Yet US primary care physician practices are more limited than the leading countries in information capacity, provide less patient access outside of ‘normal' work hours, and are among the least likely to use teams or to receive financial rewards for quality," the report says.

The results of the survey were presented last week in Washington, DC. Referring to the 2004 GP contract, the health secretary for England, Patricia Hewitt, said the results showed that "the new contract has really worked." She said, "We can build on what we're doing."

She described a team approach to delivering care in the community. In orthopaedics, for example, teams providing physiotherapy in the community were freeing consultants to deal with patients needing surgery and reducing waiting times. She also spoke of improving out of hours care and making primary care, secondary care, and ambulance services more responsive.

Carolyn Clancy, director of the US Federal Agency for Healthcare Research and Quality, said that the strength of the United States was to test innovations. The US goal is more access to electronic records, she said. Already, the US Department of Veterans Affairs, which cares for people who have served in the armed forces, provides primary care doctors with 100% electronic access to medical records.

The survey, by the Commonwealth Fund, an independent foundation that aims to increase healthcare coverage and quality, interviewed about 1000 doctors in each of the UK, the US, Australia, Germany, and the Netherlands and about 500-600 doctors in Canada and New Zealand between February and July 2006.

The US and Canada lagged behind the other countries in access to care after hours and in the use of electronic medical records to alert doctors to drug interactions and the need for check ups. Doctors in the US and Canada had difficulty generating lists of patients with chronic diseases such as diabetes or those who were taking certain drugs. GPs in other countries said this was easy.

"Canadian and US [electronic information] systems lag well behind those of other countries," the report says. Worse yet, about 40% of US and Canadian doctors do not have any reminder, alert, or prompt system—manual or otherwise—to tell them when patients need a check up or test.

US doctors said their patients sometimes or often had difficulty paying for medical care or for prescription drugs, a much higher rate than in other countries in the survey. Even people with health insurance in the US face "deductibles" and "copayments" not covered by insurance when they receive care, the report noted.

Doctors in the UK were the most likely to say they had financial incentives to improve care, whereas US doctors were the least likely to report incentives for managing patients with chronic diseases, for example.

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