TY - JOUR
T1 - Doctors' experience of coordination across care levels and associated factors: a cross-sectional study in public healthcare networks of six Latin American countries
AU - Vazquez, Maria-Luisa
AU - Vargas, Ingrid
AU - Garcia-Subirats, Irene
AU - Unger, Jean-Pierre
AU - De Paepe, Pierre
AU - Mogollon-Perez, Amparo Susana
AU - Samico, Isabella
AU - Eguiguren, Pamela
AU - Cisneros, Angelica-Ivonne
AU - Huerta, Adriana
AU - Muruaga, Maria-Cecilia
AU - Bertolotto, Fernando
N1 - NPP
PY - 2017
Y1 - 2017
N2 - Improving coordination between primary care (PC) and secondary care (SC) has become a policy priority in recent years for many Latin American public health systems looking to reinforce a healthcare model based on PC. However, despite being a longstanding concern, it has scarcely been analyzed in this region. This paper analyses the level of clinical coordination between PC and SC experienced by doctors and explores influencing factors in public healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. A cross-sectional study was carried out based on a survey of doctors working in the study networks (348 doctors per country). The COORDENA questionnaire was applied to measure their experiences of clinical management and information coordination, and their related factors. Descriptive analyses were conducted and a multivariate logistic regression model was generated to assess the relationship between general perception of care coordination and associated factors. With some differences between countries, doctors generally reported limited care coordination, mainly in the transfer of information and communication for the follow-up of patients and access to SC for referred patients, especially in the case of PC doctors and, to a lesser degree, inappropriate clinical referrals and disagreement over treatments, in the case of SC doctors. Factors associated with a better general perception of coordination were: being a SC doctor, considering that there is enough time for coordination within consultation hours, job and salary satisfaction, identifying the PC doctor as the coordinator of patient care across levels, knowing the doctors of the other care level and trusting in their clinical skills. These results provide evidence of problems in the implementation of a primary care-based model that require changes in aspects of employment, organization and interaction between doctors, all key factors for coordination. (C) 2017 The Authors. Published by Elsevier Ltd.
AB - Improving coordination between primary care (PC) and secondary care (SC) has become a policy priority in recent years for many Latin American public health systems looking to reinforce a healthcare model based on PC. However, despite being a longstanding concern, it has scarcely been analyzed in this region. This paper analyses the level of clinical coordination between PC and SC experienced by doctors and explores influencing factors in public healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. A cross-sectional study was carried out based on a survey of doctors working in the study networks (348 doctors per country). The COORDENA questionnaire was applied to measure their experiences of clinical management and information coordination, and their related factors. Descriptive analyses were conducted and a multivariate logistic regression model was generated to assess the relationship between general perception of care coordination and associated factors. With some differences between countries, doctors generally reported limited care coordination, mainly in the transfer of information and communication for the follow-up of patients and access to SC for referred patients, especially in the case of PC doctors and, to a lesser degree, inappropriate clinical referrals and disagreement over treatments, in the case of SC doctors. Factors associated with a better general perception of coordination were: being a SC doctor, considering that there is enough time for coordination within consultation hours, job and salary satisfaction, identifying the PC doctor as the coordinator of patient care across levels, knowing the doctors of the other care level and trusting in their clinical skills. These results provide evidence of problems in the implementation of a primary care-based model that require changes in aspects of employment, organization and interaction between doctors, all key factors for coordination. (C) 2017 The Authors. Published by Elsevier Ltd.
KW - Latin america
KW - Care coordination
KW - Care integration
KW - Integrated delivery systems
KW - Health-care surveys
KW - Primary health care
KW - Quality of health care
KW - Health services research
KW - BRAZIL
KW - SPECIALISTS
KW - COLOMBIA
KW - COMMUNICATION
KW - BARRIERS
U2 - 10.1016/j.socscimed.2017.04.001
DO - 10.1016/j.socscimed.2017.04.001
M3 - A1: Web of Science-article
VL - 182
SP - 10
EP - 19
JO - Social Science and Medicine
JF - Social Science and Medicine
SN - 0277-9536
ER -