Factores que influyen en el uso de mecanismos de coordinación entre niveles asistenciales en Colombia

León-Arce, Heisel Gloria; Mogollón-Pérez, Amparo Susana; Lorenzo, Ingrid Vargas; Vázquez, María Luisa

doi:10.1016/j.gaceta.2019.06.005

Cited by 12 publications

(22 citation statements)

References 20 publications

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“…13,15 This could have been due to health service providers prioritising productivity indicators (doctors not being freed for in-service training), having a negative impact on the quality of care. 3,16,29 However, increased knowledge of MJs in Network 1 in 2017 was consistent with this mechanism being introduced in the network as an intervention for improving clinical coordination between PC and SC. 26 Reduced knowledge regarding direct institutional communication mechanisms (telephone and e-mail) and reduced use of R/RLs in 2017 (especially in Network 2) could have resulted from shared EMR being introduced, thereby facilitating access to and exchange of patients' clinical information between care levels and hence, discouraging the use of electronic or paper R/RLs.…”

Section: Broad Knowledge Of Information Coordination Mechanisms Thmentioning

confidence: 80%

“…Evaluating knowledge and use of CCMs has been limited in Latin American, despite their importance regarding improving healthcare quality. 3,16,29 This study aimed at contributing to understanding them by analysing the situation in two public healthcare networks of a health system based on a managed competition model. The results identified important elements to be considered when introducing strategies for improving their use and which can be used in different health systems.…”

Section: Discussionmentioning

confidence: 99%

“…qualitative studies' results in Colombia. 3,16 This could be explained by a PC doctor's referral being obligatory for gaining access to SC 24 and HDRs being required for discharging patients. 25 Whilst CPGs are obligatory, they are not usually shared by care levels and are drawn up to meet health service accreditation criteria.…”

Section: Broad Knowledge Of Information Coordination Mechanisms Thmentioning

confidence: 99%

“…-147 organisational barriers became evident when analysing the reasons for non-receipt; referral letters were used for administrative purposes (i.e., for authorising specialist services) and both mechanisms were often not handed in or became lost by patients (the main means by which R/RLs and HDRs reach the other care level) in keeping with other studies' findings. [16][17][18] It could also be related to SC doctors not having sufficient time being available (indicated as a difficulty regarding R/RLs use) and/or low specialist interest in exchanging information with PC. These problems coincided with other studies' findings 3,16,29,32,33 This could also be related to organisational barriers.…”

Section: Limited Use and Difficulties Regarding The Use Of Existingmentioning

confidence: 99%

“…[12][13][14][15] Few studies in Latin America, particularly in Colombia, have analysed the knowledge and use of CCMs and highlight limited knowledge of coordination mechanisms and problems regarding the use of mechanisms for coordinating information between care levels. 3,[16][17][18][19] The Colombian General System of Social Security in Health, which is based on a managed competition model, consists of two health insurance schemes: a contributory one for employees from the formal sector and those who can pay and a subsidised one for the low income population. 20 The insurers (competing for affiliates) guarantee health service provision by contracting it with private and public health service providers (who compete for contracts).…”

Section: Introductionmentioning

confidence: 99%

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Changes in knowledge and use of clinical coordination mechanisms between care levels in healthcare networks of Colombia

León-Arce

Mogollón-Pérez

Vargas

et al. 2020

Health Planning & Management

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Clinical coordination mechanisms (CCMs) have become key tools in healthcare networks for improving coordination between primary care (PC) and secondary care (SC) and are particularly relevant in health systems with highly fragmented healthcare provision. However, their implementation has been little studied to date in Latin America and particularly in Colombia. This study analyses the level of knowledge and use of CCMs between care levels and their changes between 2015 and 2017 in two public healthcare networks in Bogotá, Colombia. Comparison of two cross-sectional studies based on surveys among PC and SC doctors working in their networks (174 doctors per network/year). The COORDENA questionnaire was used for measuring knowledge concerning CCMs and the frequency of use and difficulties involved in using referral/ reply letters (R/RLs) and hospital discharge reports (HDRs). Descriptive bivariate analysis and Poisson regression models with robust variance were used for analysing differences between networks and years. The results for both networks and years revealed greater knowledge and use of information coordination mechanisms than those regarding clinical management coordination (though their knowledge increased in 2017). Although widely known and used, significant problems regarding infrequent and late receipt of RLs and HDRs in PC as well as the poor quality of their

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Section: Broad Knowledge Of Information Coordination Mechanisms Thmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Broad Knowledge Of Information Coordination Mechanisms Thmentioning

confidence: 99%

Section: Limited Use and Difficulties Regarding The Use Of Existingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Changes in knowledge and use of clinical coordination mechanisms between care levels in healthcare networks of Colombia

León-Arce

Mogollón-Pérez

Vargas

et al. 2020

Health Planning & Management

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Strategies, Information Technologies and Models for Knowledge Management in Software Development Companies: A Systematic Review of the Literature

Fragoso,

Villa,

Marín

2023

Communications in Computer and Information Science

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Assessing the impact of clinical coordination interventions on the continuity of care for patients with chronic conditions: participatory action research in five Latin American countries

Espinel-Flores

Vargas

Eguiguren

et al. 2021

Health Policy and Planning

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Although fragmentation in the provision of services is considered an obstacle to effective health care, there is scant evidence on the impact of interventions to improve care coordination between primary care and secondary care in terms of continuity of care –i.e. from the patient perspective– particularly in Latin America (LA). Within the framework of the Equity-LA II project, interventions to improve coordination across care levels were implemented in five LA countries (Brazil, Chile, Colombia, Mexico and Uruguay) through a participatory action research (PAR) process. This paper analyses the impact of these PAR interventions on the cross-level continuity of care of chronic patients in public healthcare networks. A quasi-experimental study was performed with measurements based on two surveys of a sample of patients with chronic conditions (392 per network; 800 per country). Both the baseline (2015) and evaluation (2017) surveys were conducted using the CCAENA questionnaire. In each country, two comparable public healthcare networks were selected, one intervention and one control. Outcomes were cross-level continuity of information and of clinical management. Descriptive analyses were conducted and Poisson regression models with robust variance fitted to estimate changes. With differences between countries, the results showed improvements in cross-level continuity of clinical information (transfer of clinical information) and of clinical management (care coherence). These results are consistent with those of previous studies on the effectiveness of the interventions implemented in each country in improving care coordination in Brazil, Chile, and Colombia. Differences between countries are probably related to particular contextual factors and events that occurred during the implementation process. This supports the notion that certain context and process factors are needed to improve continuity of care. The results provide evidence that, although the interventions were designed to enhance care coordination and aimed at health professionals, patients report improvements in continuity of care.

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Factores que influyen en el uso de mecanismos de coordinación entre niveles asistenciales en Colombia

Cited by 12 publications

References 20 publications

Changes in knowledge and use of clinical coordination mechanisms between care levels in healthcare networks of Colombia

Changes in knowledge and use of clinical coordination mechanisms between care levels in healthcare networks of Colombia

Strategies, Information Technologies and Models for Knowledge Management in Software Development Companies: A Systematic Review of the Literature

Assessing the impact of clinical coordination interventions on the continuity of care for patients with chronic conditions: participatory action research in five Latin American countries

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