Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, ES08022 Barcelona, Spain.
Public Sector Care Unit, Department of Public Health, Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerpen, Belgium.
Soc Sci Med. 2017 Jun;182:10-19. doi: 10.1016/j.socscimed.2017.04.001. Epub 2017 Apr 3.
Improving coordination between primary care (PC) and secondary care (SC) has become a policy priority in recent years for many Latin American public health systems looking to reinforce a healthcare model based on PC. However, despite being a longstanding concern, it has scarcely been analyzed in this region. This paper analyses the level of clinical coordination between PC and SC experienced by doctors and explores influencing factors in public healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. A cross-sectional study was carried out based on a survey of doctors working in the study networks (348 doctors per country). The COORDENA questionnaire was applied to measure their experiences of clinical management and information coordination, and their related factors. Descriptive analyses were conducted and a multivariate logistic regression model was generated to assess the relationship between general perception of care coordination and associated factors. With some differences between countries, doctors generally reported limited care coordination, mainly in the transfer of information and communication for the follow-up of patients and access to SC for referred patients, especially in the case of PC doctors and, to a lesser degree, inappropriate clinical referrals and disagreement over treatments, in the case of SC doctors. Factors associated with a better general perception of coordination were: being a SC doctor, considering that there is enough time for coordination within consultation hours, job and salary satisfaction, identifying the PC doctor as the coordinator of patient care across levels, knowing the doctors of the other care level and trusting in their clinical skills. These results provide evidence of problems in the implementation of a primary care-based model that require changes in aspects of employment, organization and interaction between doctors, all key factors for coordination.
近年来，许多拉丁美洲公共卫生系统希望加强以初级保健为基础的医疗模式，将初级保健（PC）和二级保健（SC）之间的协调作为政策重点。然而，尽管这是一个长期存在的问题，但在该地区几乎没有得到分析。本文分析了阿根廷、巴西、智利、哥伦比亚、墨西哥和乌拉圭公共医疗网络中医生之间的临床协调程度，并探讨了影响因素。这是一项基于对研究网络中医生（每个国家 348 名医生）进行调查的横断面研究。采用 COORDENA 问卷衡量他们的临床管理和信息协调经验，以及相关因素。进行了描述性分析，并生成了多变量逻辑回归模型，以评估对护理协调的总体看法与相关因素之间的关系。尽管各国之间存在一些差异，但医生普遍报告说，护理协调有限，主要是在信息传递和沟通方面，以便对患者进行后续治疗和获得 SC 治疗，特别是在 PC 医生的情况下，在 SC 医生的情况下，不太适当的临床转诊和治疗意见不合的情况更为严重。与更好的协调总体看法相关的因素包括：作为 SC 医生、认为在咨询时间内有足够的时间进行协调、对工作和薪酬的满意度、确定 PC 医生为各级患者护理的协调者、了解其他护理水平的医生并信任他们的临床技能。这些结果提供了实施以初级保健为基础的模式方面存在问题的证据，这些问题需要在就业、组织和医生之间的互动方面进行变革，这些都是协调的关键因素。
