Impact of a standardized communication system on continuity of care between family physicians and the emergency department

CAN-MA-Standard Family Physicians Communication

Canada (ED)

Objective: It has been   suggested that continuity of care is hampered because of the lack of   communication between emergency departments (EDs) and primary care providers.   A web-based, standardized communication system (SCS) that enables family   physicians (FPs) to visualize information regarding their patients' ED visits   was developed. This paper aims to evaluate the impact of this SCS on   continuity of care. 


Methods: We conducted an open, 4-period crossover, cluster-randomized   controlled trial of 23 FP practices. During the intervention phase, FPs   received detailed reports via SCS, while in the control phase they received   mailed copies of the ED notes. Continuity of care was evaluated with a web   questionnaire completed by FPs 21 days after the ED visit. The primary   measures of continuity of care were knowledge of ED visit (quality and   quantity), patient management and follow-up rate.


Results: We analyzed a total of 2022 ED visits (1048 intervention and   974 control). The intervention group received information regarding the ED   visit more often (odds ratio [OR] 3.14, 95% confidence interval [CI]   2.6-3.79), found the information more useful (OR 5.1, 95% CI 3.49-7.46),   possessed a better knowledge of the ED visit (OR 6.28, 95% CI 5.12-7.71),   felt they could better manage patients (OR 2.46, 95% CI 2.02-2.99) and   initiated actions more often following receipt of information (OR 1.62, 95%   CI 1.36-1.93). However, there was no significant difference in the follow-up   rate at FPs offices (OR 1.25, 95% CI 0.97-1.61).


Conclusion: The use of SCS between an ED and FPs led to significant   improvements in continuity of care by increasing the usefulness of   transferred information and by improving FPs' perceived patient knowledge and   patient management.


Authors: Marc Afilalo, Eddy Lang, Ruth Léger, Xiaoqing Xue, Antoinette Colacone, Nathalie Soucy, Alain Vandal, Jean-François Boivin, Bernard Unger

Marc Afilalo - marc.afilalo@mcgill.ca

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