Doctors' experience of coordination across care levels and associated factors. A cross-sectional study in public healthcare networks of six Latin American countries
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2017-06Metadata
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Vásquez, María Luisa
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Doctors' experience of coordination across care levels and associated factors. A cross-sectional study in public healthcare networks of six Latin American countries
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Abstract
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.
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Seventh Framework Programme
305197
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Artículo de publicación ISI
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URI: https://repositorio.uchile.cl/handle/2250/146965
DOI: 10.1016/j.socscimed.2017.04.001
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Social Science & Medicine 182 (2017) 10-19
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