Care coordination between specialty care and primary care: a focus group study of provider perspectives on strong practices and improvement opportunities

Abstract

Care coordination between the specialty care provider (SCP) and the primary care provider (PCP) is a critical component of safe, efficient, and patient-centered care. Veterans Health Administration conducted a series of focus groups of providers, from specialty care and primary care clinics at VA Medical Centers nationally, to assess 1) what SCPs and PCPs perceive to be current practices that enable or hinder effective care coordination with one another and 2) how these perceptions differ between the two groups of providers. A qualitative thematic analysis of the gathered data validates previous studies that identify communication as being an important enabler of coordination, and uncovers relationship building between specialty care and primary care (particularly through both formal and informal relationship-building opportunities such as collaborative seminars and shared lunch space, respectively) to be the most notable facilitator of effective communication between the two sides. Results from this study suggest concrete next steps that medical facilities can take to improve care coordination, using as their basis the mutual understanding and respect developed between SCPs and PCPs through relationship-building efforts.

Keywords:

• referral and consultation
• interdepartmental relations
• multidisciplinary communication
• qualitative research

Supplementary materials

Number of responses for all themes

Communication

Themes related to relationships, training, and communication between specialty care (SC) and primary care (PC) provider (SCP and PCP) teams (~29% of total number of responses)

Table S1 Communication themes

Table S2 Tasks structure themes

Tasks structure

Themes related to task guidelines and standards (ie, what is expected to be done) (~19% of total number of responses)

Table S3 Patient perception themes

Patients

Themes related to patient perceptions, quality of care for patients, and patient characteristics (~14% of total number of responses)

Table S4 Organizational role themes

Roles clarity

Themes related to organizational roles (ie, who is responsible for what) (~13% of total number of responses)

Table S5 Geographical distance themes

Infrastructure

Themes related to geographical distances, outpatient clinics, space, and information systems and technology (~9% of total number of responses)

Table S6 Supply/staffing and workload balance themes

Workload

Themes related to supply/staffing and workload balance (~9% of total number of responses)

Access

Themes related to access for patient appointments and availability to reach SCPs/PCPs on the phone (~7% of total number of responses)

Table S7 Access themes

Acknowledgments

The authors would like to thank Cliona Archambeault and Dr James Schlosser for their generous input and comments, Rael Elstein and Anuradha Ramanath for their contributions to the thematic coding, Jenniffer Leyson for her guidance on qualitative analysis, as well as the moderators, facility points-of-contact, and focus group participants for their involvement in the study.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.

Disclosure

The authors report no conflicts of interest in this work.