Factors associated to experienced continuity of care between primary and outpatient secondary care in the Catalan public healthcare system

Abstract

Users generally reported continuity of care, although elements of discontinuity were also identified, which can be partially explained by the healthcare setting and some individual factors. Elements of discontinuity should be addressed to better adapt care to patients' needs.

Continuity of clinical management and information across care levels: perceptions of users of different healthcare areas in the Catalan national health system

“…Although conceptual discussions are ongoing, an increasing number of qualitative and quantitative studies, for example those of Cowie et al [16], Aller et al [17, 18] or Uijen et al [19], have adopted Reid et al’s framework [4, 9]. They define continuity of care as one patient experiencing care over time as connected and coherent with his or her health needs and personal circumstances [20].…”

“…Results suggested differences related to age and educational level – the elderly population is more likely to perceive higher levels of continuity of clinical management and information [7, 18, 21], whilst higher education was significantly associated with lower ratings [21] – but the influence of socioeconomic level, health status or sex on the continuity types is inconclusive [7, 18, 21]. The analysis of factors related to health services organizations and health professionals was targeted in two quantitative studies; one conducted in Catalonia, Spain [17] and the other in Quebec, Canada [22]. Results showed that healthcare areas (which differed in the management model of primary and secondary care) [17] and operational agreements with other healthcare establishments (mostly shared-care protocols and mechanisms for facilitated referrals and information sharing) were associated with all three continuity types [17, 22].…”

“…The analysis of factors related to health services organizations and health professionals was targeted in two quantitative studies; one conducted in Catalonia, Spain [17] and the other in Quebec, Canada [22]. Results showed that healthcare areas (which differed in the management model of primary and secondary care) [17] and operational agreements with other healthcare establishments (mostly shared-care protocols and mechanisms for facilitated referrals and information sharing) were associated with all three continuity types [17, 22]. In qualitative research, influencing factors predominantly emerged as a by-product of the study results, i.e., their identification was not the study objective, with a few exceptions [11, 13, 23, 24], or seemed to be entangled with the elements that defined continuity.…”

“…This diversity of providers has originated various management models for the joint management of primary and secondary care, such as integrated healthcare networks [33]. In Catalonia, empirical evidence on the three continuity types is scant, except for a population survey using the CCAENA© questionnaire [17, 18] and a qualitative multiple case study with COPD patients attended to at different integrated healthcare networks [34]. Other surveys of the Catalan NHS – the CatSalut Satisfaction Survey Plan (PLAENSA©) [35] and the Health Survey of Barcelona [36] – seek the citizens’ perception in terms of quality and satisfaction and thus include only specific items related to continuity of care, for instance information transfer across levels or waiting times for a secondary care visit.…”

“…Other surveys of the Catalan NHS – the CatSalut Satisfaction Survey Plan (PLAENSA©) [35] and the Health Survey of Barcelona [36] – seek the citizens’ perception in terms of quality and satisfaction and thus include only specific items related to continuity of care, for instance information transfer across levels or waiting times for a secondary care visit. Results suggest that transitions between primary and secondary care were mostly reported by patients to be connected and consistent; however some noteworthy elements of discontinuity were identified, for example long waiting times for secondary care after a referral [17, 34] or gaps in the information transfer across levels [17]. The need for an in-depth analysis to explore the rationales that could explain these results and thus to understand the full complexity of the phenomenon has been postulated [17].…”