The 4 principles for primary care, specialist collaboration


Lack of coordination can lead to fragmentation, errors, patient frustration.

Partnerships, defined roles, communication and data sharing are four principles that should underpin collaboration between primary care providers and health care specialists, according to the American College of Physicians (ACP).

The organization published a new position paper to lay out how lack of care coordination can cause fragmented care, increase risk of error and create frustration for patients and physicians.

The paper, “Beyond the Referral: Principles of Effective, Ongoing Primary and Specialty Care Collaboration,” outlines how the process should be improved.

“The ways in which our health care system coordinates care between primary and specialty care physicians is broken,” ACP President George M. Abraham, MD, said in a press release. “Our patients can find the experience frustrating; physicians can often find information they need about their patients difficult to obtain, and we know that together we could be doing better.”

The ACP paper outlines four guiding principles for primary care and specialty care collaborations:

  • Patient and family partnering.

Clinical care teams should work collaboratively with patients, families, and caregivers to empower them to be active partners in all aspects of their care. Their needs, preferences, and limitations should be actively predicted, solicited, and considered in all care encounters and decisions.

  • Defined clinical roles and responsibilities.

The roles, responsibilities, and mutual expectations of primary care and specialty care team members should be clear and acceptable to all parties, including the patient and family.

  • Timely, productive communication.

All parties should engage in timely, informative, and focused communication with one another that highlights critical issues or items needing action.

  • Effective data sharing.

Patient data should be shared in a timely, thorough, actionable, and well-organized manner.

Included with the paper, ACP also published a 39-page playbook that defines what is needed for each specific role or working relationship when more than one clinician is involved in the care of a patient. The playbook outlines critical elements of both a referral request and response.

Abraham presented the paper on April 29 with Carol Greenlee, MD, prior chair of ACP Council of Subspecialty Societies and an author of the paper, and Shari Erickson, ACP chief advocacy officer and senior vice president of governmental affairs and public policy. The panel took place at Internal Medicine Meeting 2022, ACP’s annual scientific meeting, held last month in Chicago.

This article was originally published by sister publication Medical Economics.

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