Quality

Continuity Visits by Primary Care Physicians Could Benefit Inpatients

“It’s not easy to work out the logistics, and it depends on the geography,” he says. “We also need to be considering telemedicine. But something to enhance continuity is ripe for innovation.”

He says consultation or continuity visits offer ways to improve care with a relatively small expenditure.

“We still see a few PCPs come in when their patients are hospitalized. It’s very reassuring to their patients,” he says. “For the complicated cases where an ongoing relationship matters, those encounters are fabulous.”

Larry Beresford is a freelance writer in Alameda, Calif.

Beyond Academia

How would the consultation visit play outside of the academic medical center? Randy J. Ferrance, DC, MD, FAAP, SFHM, medical director of the hospitalist service, hospice, and hospital-based quality at Riverside Tappahannock Hospital in Virginia, says few PCPs in his locale would be interested in making such visits.

“They say they are willing to work in our area only because there is a hospitalist service,” says Dr. Ferrance, “and, therefore, they never have to come to the hospital.”

For some PCPs, the hospital is a one-hour drive, each way, from their office.

“We have a few PCPs who really don’t want to keep in touch with us at all about their hospitalized patients,” he says. “When we’ve tried to contact them, they tell us that the history and physical and discharge summary are plenty of communication.”

Others call their patients in the hospital daily to check in, Dr. Ferrance says, and then will call the hospitalist.

“Or, we call them every other day or so to keep them up to date,” he says.

Brian Bossard, MD, FACP, FHM, founder and medical director of Inpatient Physician Associates in Lincoln, Neb., says he thinks the consultation visits are not viable and would place an unnecessary burden on already overworked PCPs in the community. He also worries about scope creep.

“A PCP consultant could confuse the chain of command,” Dr. Bossard says.

Continuity at the time of discharge remains an important concern, he says. A follow-up physician contact within 72 hours and a discharge summary, including medication reconciliation within 24 hours, are essential to ensure excellent continuity of care. But a PCP visit to the hospital is “wildly impractical.”

“PCPs won’t do it because they know their patients receive outstanding patient care from hospitalists without this interaction,” he says.

—Larry Beresford

References

  1. Goroll AH, Hunt DP. Bridging the hospitalist-primary care divide through collaborative care. New Engl J Med. 2015;372(4):308-309.
  2. Wachter RM, Pantilat SZ. The “continuity visit” and the hospitalist model of care. Dis Mon. 2002;48(4):267-272.
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Comments

  1. N Parikh MD

    I find this article and like articles fascinating as most community primary care docs are kicked out by the hospital systems at least here in South Florida. They get a contract with hospitalist companies and take us off ER call. As the article correctly points out, the hospitalist have limited knowledge of the patients history and goals. Moreover, I find the hospitalist of little knowledge on what meds the patients insurance actually covers-often times discharging on meds not covered or very expensive for the patient leading to non-compliance.
    Against, I see articles like this saying how important it is for the community docs to be involved. At least in Sofl, community docs are kicked off ER call in favor of salaried docs by the hospital. Corporations are now running our healthcare system, not the docs! This is why despite all the modern changes to healthcare, there is little or no improved outcomes nor any improvement in cost of healthcare.

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