Call for Inclusion of PCPs in Hospital Teams

Internal medicine researchers from Massachusetts General Hospital have proposed a collaborative model that coordinates primary care practitioners (PCPs) and hospitalists [N Engl J Med. 2015; DOI:10.1056/NEJMp1411416].

Allan Goroll, MD, and Daniel Hunt, MD, said that under their plan, PCPs would become consultants to the hospitalists' team. The PCP would visit patients within 12 to 18 hours of admission to give support and counseling and recommend a care plan.

The proposal aims to both reduce hospitalists' workloads and better personalize care. The PCP would write a consultation note containing the patient's personal and medical history and recommendations for care.

The knowledge from PCPs would help hospitalists who need to make quick decisions for patients they have just met, especially end-of-life decisions, according to the authors. The hospitalist would retain full attending physician responsibilities.

After the initial visit, the PCP would be available to meet with the patient or family or care team on an as-needed basis and would return for consultation before discharge.

Previous proposals for better continuity of care have included the notion of PCPs serving as an attending for their patients in hospitals on a rotating basis or embedding a small group of hospitalists into a primary care group. However, problems with logistics, scheduling, payment, and interfacing medical systems have limited the adoption of these models.

A key question is whether PCPs have time to fulfill the consulting role, the authors noted, especially those in small practices reimbursed under traditional fee-for-service models.—Kerri Fitzgerald