Do primary and secondary care doctors have a different experience and perception of cross-level clinical coordination? Results of a cross-sectional study in the Catalan National Health System (Spain)

Abstract

Background Clinical coordination across care levels is a priority for health systems around the world, especially for those based on primary health care. The aim of this study is to analyse the degree of clinical information and clinical management coordination across healthcare levels in the Catalan national health system experienced by primary (PC) and secondary care (SC) doctors and explore the associated factors. Methods Cross-sectional study based on an online survey using the self-administered questionnaire COORDENA-CAT. Data collection: October–December 2017. Study population: PC and SC (acute and long term) doctors of the Catalan national health system. Participation rate was 21%, with a sample of 3308 doctors. Outcome variables: cross-level clinical information coordination, clinical management coordination, and perception of cross-level coordination within the area. Explanatory variables: socio-demographic, employment characteristics, attitude towards job, type of area (according to type of hospital and management), interactional factors, organizational factors and knowledge of existing coordination mechanisms. Stratification variable: level of care. Descriptive and multivariate analysis by logistic regression. Results The degree of clinical coordination experienced across levels of care was high for both PC and SC doctors, although PC doctors experienced greater exchange and use of information and SC doctors experienced greater consistency of care. However, only 32.13% of PC and 35.72% of SC doctors found that patient care was coordinated across care levels within their area. In both levels of care, knowing the doctors of the other level, working in an area where the same entity manages SC and majority of PC, and holding joint clinical case conferences were factors positively associated with perceiving high levels of clinical coordination. Other associated factors were specific to the care level, such as being informed of a patient’s discharge from hospital for PC doctors, or trusting in the clinical skills of the other care level for SC doctors. Conclusions Interactional and organizational factors are positively associated with perceiving high levels of clinical coordination. Introducing policies to enhance such factors can foster clinical coordination between different health care levels. The COORDENA questionnaire allows us to identify fields for improvement in clinical coordination.

Understanding How to Improve the Use of Clinical Coordination Mechanisms between Primary and Secondary Care Doctors: Clues from Catalonia

“…These last two sections are the focus of this paper. Details on the adaptation, validation and structure of the questionnaire and on data collection have already been published [ 14 , 34 ].…”

“…Cross-level clinical coordination mechanisms can play an important role in addressing this challenge [ 3 , 4 ] due to their potential to improve the transfer of clinical information and communication between primary care (PC) and secondary care (SC) doctors [ 5 , 6 ], thus reducing delays, duplication of exams and medical errors, as well as SC patient consultations and waiting times [ 7 , 8 , 9 , 10 ]. Despite their importance, previous studies highlight the limited use (or problems in the use) of cross-level coordination mechanisms, both at a national and international level [ 11 , 12 , 13 , 14 ], suggesting that they have not been adopted as expected. Health systems need to gain further understanding of the factors and difficulties influencing the utilization of coordination mechanisms in order to adapt them and improve their adoption rates and thus, their effectiveness.…”

“…However, evidence on the factors [ 23 , 24 , 25 ] and barriers [ 12 , 26 , 27 ] hindering the use of care coordination mechanisms generally focuses on a single type of mechanism, despite the fact that these factors and barriers may influence the use of each coordination mechanism differently [ 28 ], and that in real life conditions, health organizations use a combination of mechanisms, which may influence each other, and hence require a more comprehensive analytical approach. Moreover, although previous studies suggest that experiences and perceptions of clinical coordination differ between levels of care [ 14 ], studies analysing the use of coordination mechanisms normally concentrate on a single care level, either PC or SC, even though PC doctors are expected to make more use of coordination mechanisms than SC doctors, due to their greater need to communicate as patient care coordinators [ 29 , 30 ], and different factors may influence their use depending on the level of care. Besides, studies exploring suggestions for improving clinical coordination from the point of view of PC and SC doctors are inexistent to date, and would provide crucial information for the successful implementation of effective reforms to promote clinical coordination.…”

“…Previous qualitative and quantitative studies conducted in the Catalan health system show limited use of cross-level coordination mechanisms and suggest that this could be related to organizational factors [ 13 , 14 , 33 ]. However, there are no comprehensive evaluations on the use of existing coordination mechanisms.…”

“…However, there are no comprehensive evaluations on the use of existing coordination mechanisms. To address this gap in knowledge, the objective of this study, which forms part of a wider study [ 14 , 34 ], is to analyze the level of use of cross-level clinical coordination mechanisms, the difficulties and factors associated with their use, and suggestions for improvement of clinical coordination in the Catalan health system.…”