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New Study Finds Fewer Doctors Visit Patients in the Hospital

Fragmented care may contribute to readmissions, low patient satisfaction, improper medication use, and higher costs.

Ever feel like you or your loved ones are shuffled from the hospital to home or nursing home without seeing any of your own doctors? You’re not alone.

Twenty or 30 years ago when a patient was admitted to the hospital, his or her doctor usually came to visit and help coordinate care. Now a new study of hospitalized Medicare patients quantifies what many already know: Most older people can’t look forward to a visit from any of their regular doctors.

A majority of Medicare patients are seen by physicians that they have never met before, according to a study published today in the Journal of the American Medical Association. The research contributes to a growing body of evidence showing that the lack of continuity of care between hospitals and homes or nursing homes contributes to poor patient satisfaction, shoddy preventive health care, improper use of medication and high hospitalization rates.

Gulshan Sharma, M.D., lead author of the study and an assistant professor in the department of internal medicine at the University of Texas Medical Branch in Galveston, Texas, says the patient-physician relationship is crucial to coordinating and connecting an individual’s care.

Sharma says if one of your regular doctors visits when you are hospitalized, “the physician knows about you, knows who you are, knows your medical history and knows what happens to you [in the hospital]. When you get out, he knows what he ordered, what he has done and what he needs to follow up on.”

Sharma and a team of researchers examined more than 3 million hospital admissions for Medicare patients from 1996 to 2006. They checked to see whether the patient’s primary care physician or any of the patient’s other physicians visited the patient in the hospital and found that in 1996 about half of the Medicare patients saw doctors they had seen before. By 2006 only 40 percent had a visit from a doctor they knew.

Hospitalized patients had even fewer visits from their primary care physicians, down from about 44 percent in 1996 to less than a third in 2006.

Previous studies have found that when people leave the hospital, they often don’t understand treatment plans, discharge information, medications or follow-up care. One recent study found that as many as 75 percent of patients can’t name any doctor who took care of them in the hospital.

Sharma says that with little financial incentive and increased patient load, many busy doctors don’t take the time to make hospital visits. Studies have shown that when older people make the transition from the hospital to another health care facility, they often have trouble remembering doctors’ instructions and aren’t sure how their recovery should progress.

“The critical time in anybody’s medical history is in these transitions,” Sharma said, adding that much is “lost in translation.” He said patient transitions can be improved by having the same physician take care of patients along the whole trajectory of illness or having better communications among doctors, hospitals and patients.

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