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Sickest Patients Expose Health Systems' Flaws

http://www.reutershealth.com/

May 6, 2003
Reuters Health
New York

Patients with health problems in five English-speaking nations are experiencing "disturbingly high rates" of medical errors, lack of care coordination, poor communication with their doctors and barriers accessing care, according to a study released Tuesday.

For heavy users of healthcare services, whether they live in Australia, Canada, New Zealand, the United Kingdom or the United States, the problems they encounter with the delivery of services and access to care are strikingly similar, researchers report in the May/June issue of the health policy journal Health Affairs.

The study is particularly relevant in the current U.S. healthcare economy since research over the years has shown the sickest individuals drive a majority of healthcare spending.

"These findings highlight serious problems with quality of care and wasted resources, making a compelling case for implementing interventions that we know will make a difference, including electronic medical records and computerized systems for physician ordering of prescription drugs," according to Karen Davis, president of the Commonwealth Fund, which participated in the study.

The study, the fifth in a continuing series that gauges patients' perceptions of their countries' healthcare systems, focuses on the recent experiences of "sicker" adults. They included people with chronic health problems or who were hospitalized or had major surgery in the past two years.

"What really is striking ... is they are much more at risk for things going wrong -- and (those things) are going wrong," said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health and lead author of the article.

At least a quarter of sicker adults in Australia, Canada, New Zealand and the U.S. and almost one-fifth of that population in the U.K. reported experiencing either a medication error or medical mistake in the past two years, according to the poll by Harris Interactive. Among those reporting errors, a majority in each country said it caused serious health problems.

Sicker adults are also particularly at risk for "breakdowns" in care coordination, the study found. One in five sicker patients in Canada and the U.S. and one in six in New Zealand had been sent for duplicative tests or procedures by different healthcare professionals. One in five respondents in the U.K. and about a quarter in the other four countries said they'd received conflicting information from different doctors and healthcare professionals.

Physician-patient communication also suffered in all five nations, although the greatest difficulties were reported in the U.S. Thirty-one percent of sicker Americans said they left the doctor's office without getting all their questions answered.

Access was another trouble spot. Half of Canadian respondents said it was difficult to see a specialist when needed. A third of U.S. adults with health problems did not fill a prescription because of cost.

The authors conclude that focusing on the small population of "intensive" users of the healthcare system could go a long way toward controlling healthcare costs and improving patient outcomes.

"Every health plan or health system can easily, from a computer, pick out these people, and they can provide them with case managers," Blendon said.

By focusing on the 10 percent to 15 percent of the population that drives most healthcare spending, healthcare providers have a better shot at avoiding medical errors, duplicative tests and communication glitches -- all the things that drive up healthcare spending.

"If they focus on this ... they can improve people's lives and they can also save money," Blendon said.
 

Copyright © 2003, Reuters Ltd.