About Half of Senior Citizens Referred to a
Specialist Never Get There for Treatment
Just 71% ever get appointments and just 70% of
those show up at doctors office
Feb. 26, 2010 Only about half of the senior
citizen patients referred to a medical specialist ever receive the
treatment their primary care doctor intended. It is referred to as the
most frequent error in medicine.
According to a new study appearing in the February
2010 issue of the Journal of Evaluation in Clinical Practice,
only 71 percent of patients age 65 or older who are referred to a
specialist are actually scheduled to be seen by that physician.
Furthermore, only 70 percent of those with an
appointment actually went to the specialist's office. Thus, only 50
percent (70 percent of 71 percent) of those referred to a specialist had
the opportunity to receive the treatment their primary care doctor
intended them to have, according to the findings by researchers from the
Regenstrief Institute and the Indiana University School of Medicine.
The Institute of Medicine, in its seminal report
"To Err is Human," defines a medical error as a "wrong plan" or a
failure of a planned action to be completed.
"Patients fail to complete referrals with
specialists for a variety of reasons, including those that the health
care system can correct, such as failure of the primary care doctor's
office to make the appointment; failure of the specialist's office to
receive the request for a consultation - which can be caused by
something as simple as a fax machine without paper - or a failure to
confirm availability with the patient," said Michael Weiner M.D.,
M.P.H., first author of the study.
"There will always be reasons health issues or
lack of transportation, for example why a referred patient cannot make
it to the specialist he or she needs, but there are many problems we
found to be correctable using health information technology to provide
more coordinated and patient-focused care. Using electronic medical
records and other health IT to address the malfunction of the referral
process, we were able to reduce the 50 percent lack of completion of
referrals rate to less than 20 percent, a significant decrease in the
medical error rate," said Dr. Weiner.
The JECP study followed 6,785 primary care patients
seen at an urban medical institution, all over age 65, with a mean age
of 72. Nearly all (91 percent) of the patients were covered by Medicare.
"This is not necessarily the fault of patients or
doctors alone, but it may take both working together along with their
health system to correct this problem. Our study highlights how
enormous a problem this is for patients who were not getting the
specialized care they needed. Although our findings would likely differ
among institutions, unfortunately overall trends are similar in other
parts of the country" said Dr. Weiner.
Notes:
This study was supported by the National Institute
on Aging.
Dr. Weiner is director of the Regenstrief
Institute's Health Services Research Program, director of the Indiana
University Center for Health Services and Outcomes Research, and
director of the VA Health Services Research and Development Center of
Excellence on Implementing Evidence-Based Practice at the Roudebush VA
Medical Center.
Co-authors of the study are Anthony J. Perkins,
M.S., of the Regenstrief Institute and the IU Center for Aging Research,
and Christopher M. Callahan, M.D., a Regenstrief Institute investigator
and Cornelius and Yvonne Pettinga Professor in Aging Research at the IU
School of Medicine. Dr. Callahan is founding director of the IU Center
for Aging Research.
The Regenstrief Institute and the IU School of
Medicine are located on the campus of Indiana University-Purdue
University Indianapolis.
Keep up with the latest news for senior citizens, baby
boomers
Feb. 26, 2010 Only about half of the senior
citizen patients referred to a medical specialist ever receive the
treatment their primary care doctor intended. It is referred to as the
most frequent error in medicine.
