Public Release: 

United States has highest rate of poor primary care coordination among 11 high-income countries

American Academy of Family Physicians

Care coordination has been identified as a key strategy for improving the effectiveness, safety and efficiency of the U.S. health care system. In new research published in the March/April issue of Annals of Family Medicine, researchers examine care coordination in 11 high-income countries and find one out of every three respondents experienced at least one coordination gap in primary care, but the overall percentage reporting poor primary care coordination was low. Notably, among the 11 countries evaluated, the United States had the highest rate of poor primary care coordination.

Analyzing 2013 Commonwealth Fund survey data from 13,958 patients from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States, researchers found the rate of poor primary care coordination was 5 percent overall and highest in the United States at 10 percent. Patients were less likely to experience poor care coordination if their primary care physician knew them well, spent sufficient time with them, involved them in care, and explained things well. Poor primary care coordination was more likely to occur among patients with chronic conditions and patients younger than 65 years.

Notably, in the United States, patients reported similar levels of poor primary care coordination regardless of insurance status, health status, income level and sex, suggesting a systemic issue in the U.S. health care system that distinguishes its efficacy of primary care coordination from that of other countries.

The authors note that care coordination gaps have been associated with a higher risk of patients experiencing a medical error, more follow-up appointments, and unnecessary health care spending. They conclude these findings warrant increased efforts to support relationships between primary care providers and patients, especially those who are younger and chronically ill.


Minding the Gap: Factors Associated With Primary Care Coordination of Adults in 11 Countries
By Jonathan Penm, BPharm, PhD, et al
University of Cincinnati, Ohio

Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed free of charge on the journal's website,

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