Following her presentation on a similar subject at this year’s American Academy of Neurology (AAN) annual meeting (5–9 April, San Diego, USA), Mary O’Neal (Brigham and Women’s Hospital, Boston, USA) speaks to NeuroNews about the fruits potentially borne out of successful collaboration between specialists and primary care providers (PCPs) in neurological care.
Why is there a need for improved collaboration between primary care and more specialised neurological centres?
Access to neurologists is currently limited, with several months of delay for patient evaluations. This challenge arises from the growing demand for neurological care, which can outpace the number of specialists available. As a result, primary care physicians often take on the responsibility of managing neurological conditions. By improving education around neurological care, PCPs could manage more cases independently, allowing neurologists to focus on more complex cases. This would also ensure that patients needing a neurological evaluation receive enhanced care before their consultation.
Do you think that, across the USA generally, there is a lack of effective collaboration between these two types of entities—and, if so, what are the likely causes of this?
I believe that, across the USA, collaboration is often limited due to siloed workflows and the demands of busy schedules. There are also breakdowns and inefficiencies in all components of the referral process stemming from incomplete transfer of information, insufficient data available for informed medical decision-making, and disagreements among different specialists over their respective roles.
How would you describe the current collaborative approach between your own hospital and nearby primary care centres?
As a neurologist at an academic centre, we typically collaborate through electronic medical records (EMR), online consultations, and emails. We also have some neurologists embedded in PCP practices, which enhances collaboration and relationship building. The effectiveness of this approach is reflected in various metrics, including reduced time to specialist visits and recommendations, decreased hospitalisations and emergency room (ER) visits, lower annual cost of care, improved patient satisfaction scores, and better provider retention and wellbeing.
What are the most important factors that more specialised physicians need to consider in attempting to improve how they work and communicate with primary care centres?
It’s important to understand what PCPs expect from the neurologist—whether it’s a one-time consultation to assist with diagnosis and management, or a full transfer of care for the patient’s neurological disorder. In turn, we must clearly communicate our expectations to the PCP, including specific questions that need to be addressed and key information from examinations, imaging, and labs—ideally through a standardised referral form. We also need to understand what the patient or their caregiver wants; for example, ease of scheduling appointments, communication among all healthcare team members, and access to care without the need for ER or hospital visits.
What are the prevailing factors that may represent a barrier to the implementation of more effective collaboration?
Potential challenges to navigate with a view to improving collaboration include securing support from hospitals and healthcare systems, gaining acceptance from all stakeholders, addressing reimbursement issues, and managing time constraints.
What do you think are the major benefits of better collaborative efforts between specialised and primary care centres?
Both neurologists and PCPs want to deliver high-quality treatment to our patients. Improving subspecialist access can be addressed in several ways, with education being a key avenue. Better education around neurological care would mean PCPs could confidently manage simple neurological disorders and reserve referrals for more complex conditions. This would reduce unnecessary demand and allow patients who most need specialist care to be seen more promptly.
