Doctors’ opinions on clinical coordination between primary and secondary care in the Catalan healthcare system

• Published in: Gaceta sanitaria 2019-01, Vol.33 (1), p.66-73
• Main Authors: Aller, Marta-Beatriz, Vargas, Ingrid, Coderch, Jordi, Calero, Sebastià, Cots, Francesc, Abizanda, Mercè, Colomés, Lluís, Farré, Joan, Vázquez-Navarrete, María-Luisa
• Format: Article
• Language: English
• Subjects: Clinical coordination between care levels; Coordinación clínica entre niveles de atención; Demography; Health Care Sciences & Services; Health Policy & Services; Infectious Diseases; Integrated health care; Interprofessional relations; Investigación cualitativa; Modelos organizativos; Organizational models; Prestación integrada de atención de salud; Psychology; Public, Environmental & Occupational Health; Qualitative research; Relaciones interprofesionales; Sociology
• ISSN: 0213-9111
• DOI: 10.1016/j.gaceta.2017.06.001

To analyse doctors’ opinions on clinical coordination between primary and secondary care in different healthcare networks and on the factors influencing it. A qualitative descriptive-interpretative study was conducted, based on semi-structured interviews. A two-stage theoretical sample was designed: 1) healthcare networks with different management models; 2) primary care and secondary care doctors in each network. Final sample size (n = 50) was reached by saturation. A thematic content analysis was conducted. In all networks doctors perceived that primary and secondary care given to patients was coordinated in terms of information transfer, consistency and accessibility to SC following a referral. However, some problems emerged, related to difficulties in acceding non-urgent secondary care changes in prescriptions and the inadequacy of some referrals across care levels. Doctors identified the following factors: 1) organizational influencing factors: coordination is facilitated by mechanisms that facilitate information transfer, communication, rapid access and physical proximity that fosters positive attitudes towards collaboration; coordination is hindered by the insufficient time to use mechanisms, unshared incentives in prescription and, in two networks, the change in the organizational model; 2) professional factors: clinical skills and attitudes towards coordination. Although doctors perceive that primary and secondary care is coordinated, they also highlighted problems. Identified factors offer valuable insights on where to direct organizational efforts to improve coordination. Analizar la opinión de los médicos sobre la coordinación entre la atención primaria (AP) y la atención especializada (AE) en diferentes redes de servicios de salud, e identificar los factores relacionados. Estudio cualitativo descriptivo-interpretativo basado en entrevistas semiestructuradas. Se diseñó una muestra teórica en dos etapas: 1) redes de servicios de salud con diferentes modelos de gestión; 2) en cada red, médicos de AP y AE. El tamaño muestral se alcanzó por saturación (n = 50). Se realizó un análisis temático de contenido. En las tres redes, los médicos expresaron que la atención está coordinada en términos de intercambio de información, consistencia y accesibilidad de AE tras derivación urgente. Sin embargo, emergieron problemas relacionados con el acceso no urgente y cambios en prescripciones, y en dos redes la inadecuación clínica de las derivaciones entre ambos