Example of a fragmented care would be the case you need to see a specialist (not your regular primary care), but (1) not able to find anyone within the same hospital/clinic or (2) your health insurance does not cover available specialists, so you have to go someplace else. As the result there no clear communication and record availability between doctors (time constraints, protection of clinical info, laziness, etc), so you end up getting care form 2 different doctors, you get prescribed medications which potentially might interact, and if not cause damage, just nil each other.
Think of elderly relative seeing psychiatrist for depression and PCP for high blood pressure, diabetes and pain. It’s clearly proven, that some blood pressure meds might cause depression, pain definitely both cause and get worsened by depression, and psychotropics (not all, but some) might increase risk factors for medical illnesses, but in many instances are also indicated as a part of pain treatment. So, if drs are aware of each others existence and treatments, they could coordinate more effectively, decreasing number of medications and improving outcomes. If not => increased risk of potentially harmful med interactions, etc.
Keep in mind, that patients not always inform drs of seeing specialist (in case of psychiatrist - fear of stigma, shame), or any other professional as well as they feel it undermines a physician.
Ideally - “Весь мир насилья мы разрушим до основанья, а затем…”
- better screening (ask pts to bring all meds and review, call pharmacies or insuarance company to get a list of all meds, some states mandate PCPs to share yearly physical results with narrow specialists, if requested, etc.)
- electronic record keeping
- allowing drs to have more time for face-to-face with patients
- insurance companies encouraging/rewarding MDs for better outcomes (I heard gossips, but how it would look in practice…???)
Получилось немного пространно и запутано, но…