The exchange of information is an integral component of continuity of health care and may limit or prevent costly duplication of tests and treatments. This study determined the probability that ...patient information from previous visits with other physicians was available for a current physician visit.
We conducted a multicentre prospective cohort study including patients discharged from the medical or surgical services of 11 community and academic hospitals in Ontario. Patients included in the study saw at least 2 different physicians during the 6 months after discharge. The primary outcome was whether information from a previous visit with another physician was available at the current visit. We determined the availability of previous information using surveys of or interviews with the physicians seen during current visits.
A total of 3250 patients, with a total of 39 469 previous-current visit combinations, met the inclusion criteria. Overall, information about the previous visit was available 22.0% of the time. Information was more likely to be available if the current doctor was a family physician (odds ratio OR 1.75, 95% confidence interval CI 1.54-1.98) or a physician who had treated the patient before the hospital admission (OR 1.33, 95% CI 1.21-1.46). Conversely, information was less likely to be available if the previous doctor was a family physician (OR 0.38, 95% CI 0.32-0.44) or a physician who had treated the patient before the admission (OR 0.72, 95% CI 0.60-0.86). The strongest predictor of information exchange was the current physician having previously received information about the patient from the previous physician (OR 7.72, 95% CI 6.92-8.63).
Health care information is often not shared among multiple physicians treating the same patient. This situation would be improved if information from family physicians and patients' regular physicians was more systematically available to other physicians.
A 54-year-old woman presented to the emergency department with increasing shortness of breath over four days. She reported an increased cough over the previous two months and that her daughter ...recently had an upper respiratory tract infection. The patient had metastatic breast cancer (estrogen-receptor positive, human epidermal growth factor receptor 2/neu negative). She had received first-line paclitaxel chemotherapy four years earlier, but severe neuropathy developed; her regimen was changed to doxorubicin weekly, with good response and a maximum lifetime cumulative dose of 450 mg/m2. Restaging performed three months before this visit showed progression in the liver, resulting in a new regimen that included everolimus and exemestane. In light of her ongoing shortness of breath, the patient had a bronchoscopy to rule out lymphangitic spread and an infectious cause; the bronchoscopy findings were negative for either cause. She was admitted to the internal medicine service for further evaluation of the unexplained dyspnea and high BNP levels. She improved substantially after diuretic therapy.
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