sábado, 10 de enero de 2009

Information Exchange among Physicians caring for the same patient in the community – Information for GP trainees/Family Medicine Residents

http://www.cmaj.ca/cgi/content/full/179/10/1013

What do we already know about this issue?
The level of exchange of clinical information among physicians is currently poor, even in countries with highly developed health systems, such as Canada. This deficitary exchange of clinical information among physicians affects the continuity of patient health care, which is assoeciated with better health outcomes. The continuity of clinical information is one of the core aspects of the continuity of health care.

What does this article add?
This article follows on from findings from previous studies and strengthens the already consolidated notion that the level of exchange of clinical information between physicians is poor.
It was interesting to realize that even though the odds are that family physicians and the regular physicians of the patients are more likely to receive information concerning previous visits from their patients to other physicians (and therefore, there are signs that they act as information hubs for their patients), the study also showed that family physicians and the patient's regular physician are also less likely to pass on clinical information to other physicians.

What implications does this article have for GP trainees/Family Medicine residents?
Trainees often realize from the outset of their vocational training that the exchange of information among the different levels of health care (specially between Primary Health Care and Secondary Health Care and vice versa) is far from perfect. A trainee in Portugal is more used to come to contact, during hospital rotations, with the paucity or even absence of written or oral communication coming from secondary or tertiary care physicians to primary care physicians, and which is related with several reasons raised in the article, which I will not develop any further.
The vocational training period is important in order to acquire certain habits related with our attitudes and professional ethics. GP/trainees/Family Medicine residents should get used early on to write referral letters and clinical information notes. During outpatient clinics in hospital rotations, they should gain the habit of replying to referral letters written by primary care physicians, or in alternative to encourage their tutors of the hospital rotations to do it during their own clinics.
During their on-call commitments, trainees should be estimulated to write the very least a brief note of clinical information when discharging patients in the emergency department (the note should include reason for admission in the emergency department, relevant findings from the history, physical examination, exams requested and ambulatory treatment prescribed) so that the family physician of these patients may become aware of these occurrences.

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