Questions
Barriers to Effective Care Coordination:
Identify and explain at least 3 major barriers that can hinder effective care coordination for chronic conditions.
Examples:
Fragmented healthcare systems with limited communication channels between providers.
Lack of patient engagement and understanding of their care plan.
Socioeconomic disparities impacting access to healthcare resources and technology.
Propose solutions to overcome these barriers and create a more coordinated care system.

Answer
1. Fragmented healthcare systems
Effective coordination requires good communication between those involved, so limited communication channels between providers can act as a major barrier to coordination. Communication can be limited in a number of ways, the most simple being the inability to contact a specific individual. This was a common issue witnessed by the author while on a GP attachment. Secretaries often did not take messages from other healthcare providers or would take a message and not pass it on. Email contacts between providers are rarely available, and faxing is now outdated. Phone calls between providers are, of course, a good way of communication. However, without a direct line to the individual, the call is often lost. The use of voicemail is not an effective form of communication.
1.1 Limited Communication Channels
Healthcare systems have areas of specialization divided amongst different providers. This can lead to a patient receiving care from multiple providers within the same health issue, resulting in duplication of tests, uneven care provided, and varied outcomes. Patients with complex needs and chronic diseases often require treatment from multiple providers and specialties. Coordination of care for these patients is often inadequate due to the division of specialization among providers (James, 2003). Effective coordination is an essential component of good healthcare delivery and can be defined as the deliberate organization of patient care activities between two or more participants involved in a patient’s care to ensure that it is safe, efficient, and cost-effective. Coordination can be complex, involving tasks from different individuals across varying facilities and specialties (Gittell et al., 2000).
Introduction to Fragmented Health Care Systems
1.1 Limited communication channels
Providers in hospitals do not receive timely information about the discharge of their patients from the hospital or consultations with specialists. The quality and completeness of clinical information available at the time of a consultation was also identified as a problem, as well as difficulties in obtaining further information from hospital doctors. Changes in patients’ medications were often unclear and undocumented. General practitioners reported that they often had to admit patients to hospital because they could not obtain the medical or paramedical support necessary to sustain them at home or in a residential care facility. In some cases, hospital doctors would not accept patient referrals. These access block problems were perceived by general practitioners to be due in part to public and/or private hospital specialists having waiting lists of their own private patients, and being less inclined to treat public patients. Failure to provide follow-up treatment advice to referring doctors was described as a disincentive to further referrals. In mental health services, the lack of a booking system for patient appointments often complicated the task of arranging specific follow-up treatments. Most of New Zealand’s new health initiatives involve some level of care coordination from primary and community care. Examples include early discharge schemes, health of the older person and disability services programs, needs assessment and long-term care following the closure of hospital beds and the shift of a wider range of medical and surgical treatments from secondary to primary care. At present the potential gains of these initiatives are often not fully realized because they are not underpinned by improved communication and coordination with secondary care services. In some cases primary care doctors have been forwarded discharge and treatment change information for their patients months after the event, and because there is often no guarantee that hospital services will re-accept referred patients, primary care teams may give up on attempts to obtain further services that their patients still require. A lack of clear communication and understanding between the providers of secondary and primary care has also meant that some of the changes to service delivery described in the Introduction have occurred in a way that is ad hoc and unplanned.
1.2 Lack of information sharing
Virtual care coordination (e-health) has become more and more common, and is the use of IT services to plan and manage patient care. Most advances are in web-based, patient-to-provider cases, as they are easy to schedule, document, and revise. These cases have maximum coordination, but think about a patient who needs to see a specialist or get a procedure done. The patient instance again has much coordination with a defined specialist and a procedure time, but these cases are not easily transferable between different sectors of the health care system. He currently still has to fax or email procedure details, with possible drug specifications to his private practice proceduralist, which is basically less than a handoff, so this information could get lost or missed in potential coordination to a follow-up case.
The main issue with destroying the concept of an effective care coordination is that although there are several different forms of care coordination, most cannot be accurately displayed or compared to the traditional method of physician to patient, and the vegetative and emergency cases. Most of this essay is based around the transfer of information from one health care system to the next, and across the broad spectrum of managing the case. Care coordination has shifted to a multidisciplinary team effort over the past decade. The concept of care coordination is taking health care out of the passive mode and the linear patient to provider model, to design patient cases with an emphasis on preventing medical mistakes and anticipating potential setbacks.
1.3 Inadequate coordination between providers
Changes are needed to ensure the right type of coordinated mental health care is provided. For this to happen, mental health specialists must define in common terms what successful coordination will look like. It is too easy to say that coordination is occurring when a patient is seen by various providers in the same agency. Measures of coordination often involve event monitoring and evaluation of treatment effectiveness on the part of the patient and involved providers. Successfully coordinated care will result in a greater effectiveness of simpler treatments in the primary care setting and less need for referral to severe psychiatric medication management. With better measures of successful coordination, it will be possible to reward managed care organizations and provider groups that are coordinating mental health services and more effectively treating mental health patients.
Inadequate coordination between healthcare providers can adversely affect patient care. A healthcare provider may recommend different medications or a treatment course that interferes with treatment priority or diagnosis from another provider. Recommendations for, but no direct referrals to, psychological evaluation or therapy can be interpreted as stigmatizing patients and result in less motivation to follow a treatment course. Patient non-adherence is common in this chaotic healthcare system scenario, as patients often feel confused about proper treatment and may not believe therapy treatment will be effective. Then healthcare providers may misinterpret non-adherence as resistance rather than a problem with access and coordination, resulting in further exacerbating mental health problems. This lack of coordination for mental health treatment is in stark contrast to the care coordination in primary care and general medical settings.
2. Lack of patient engagement and understanding
2.1 Limited health literacy
2.2 Insufficient patient education
2.3 Ineffective communication with patients
2.4 Non-adherence to care plans
3. Socioeconomic disparities impacting access to healthcare resources
3.1 Financial barriers
3.2 Limited availability of healthcare facilities
3.3 Inadequate transportation options
4. Technological challenges in care coordination
4.1 Lack of interoperability between systems
4.2 Inconsistent use of electronic health records
4.3 Limited access to telehealth services
5. Proposed solutions for fragmented healthcare systems
5.1 Implementing care coordination platforms
5.2 Enhancing communication channels between providers
5.3 Establishing care teams and care coordinators
6. Proposed solutions for lack of patient engagement and understanding
6.1 Improving health literacy programs
6.2 Enhancing patient education materials
6.3 Promoting shared decision-making
6.4 Utilizing digital health tools for patient engagement
7. Proposed solutions for socioeconomic disparities
7.1 Expanding access to affordable healthcare services
7.2 Implementing transportation assistance programs
7.3 Addressing social determinants of health
8. Proposed solutions for technological challenges
8.1 Advancing interoperability standards
8.2 Encouraging widespread adoption of electronic health records
8.3 Expanding telehealth infrastructure and reimbursement policies