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

Abstract

Clinical coordination between primary (PC) and secondary care (SC) is a challenge for health systems, and clinical coordination mechanisms (CCM) play an important role in the interface between care levels. It is therefore essential to understand the elements that may hinder their use. This study aims to analyze the level of use of CCM, the difficulties and factors associated with their use, and suggestions for improving clinical coordination. A cross-sectional online survey-based study using the questionnaire COORDENA-CAT was conducted with 3308 PC and SC doctors in the Catalan national health system. Descriptive bivariate analysis and logistic regression models were used. Shared Electronic Medical Records were the most frequently used CCM, especially by PC doctors, and the one that presented most difficulties in use, mostly related to technical problems. Some factors positively associated with frequent use of various CCM were: working full-time in integrated areas, or with local hospitals. Interactional and organizational factors contributed to a greater extent among SC doctors. Suggestions for improving clinical coordination were similar between care levels and related mainly to the improvement of CCM. In an era where management tools are shifting towards technology-based CCM, this study can help to design strategies to improve their effectiveness.

Designing and describing an electronic referral system to facilitate direct hospital admissions

“…The third lever of sustainability of the project will also require the consideration of the remuneration of the actors involved in this coordination. Indeed, as doctors emphasized in a study in Catalonia, organizational factors such as coordination time are just as important as digital tools [ 43 ], which means that funding must be provided. Finally, Ekwegh et al insisted on the importance of collaborative work between PCPs and hospital doctors for the development of their tool, a collaborative tool that is quite similar to the tool that we have developed in our project [ 34 ]; however, there are still very few formalized primary-secondary care networks that aim to develop collaboration and perpetuate this type of initiative [ 44 ].…”

Continuidade da gestão clínica entre níveis assistenciais: experiências dos usuários de uma rede municipal de saúde

“…A comunicação entre médicos de distintos níveis é um tema bastante citado na literatura. Alguns estudos 25,26,27,28 sugerem que, quando a comunicação entre níveis é deficiente, a implantação de mecanismos de coordenação e compartilhamento de informações pode fornecer soluções, favorecendo o contato e a colaboração entre os profissionais. A comunicação entre os profissionais pode ser facilitada pela utilização de tecnologias de informação em saúde, como o prontuário eletrônico do paciente, que possibilita o acesso às informações sobre o paciente e o compartilhamento do plano de cuidados entre os níveis 29,30 .…”