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

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Abstract

Objective: To analyse doctors’ opinions on clinical coordination between primary and secondary care in different healthcare networks and on the factors influencing it. Methods: 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. Results: 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. Conclusions: 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.

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Aller, M. B., Vargas, I., Coderch, J., Calero, S., Cots, F., Abizanda, M., … Vázquez-Navarrete, M. L. (2019). Doctors’ opinions on clinical coordination between primary and secondary care in the Catalan healthcare system. Gaceta Sanitaria, 33(1), 66–73. https://doi.org/10.1016/j.gaceta.2017.06.001

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