Aller Marta-Beatriz, Vargas Ingrid, Coderch Jordi, Calero Sebastià, Cots Francesc, Abizanda Mercè, Colomés Lluís, Farré Joan, Vázquez-Navarrete María-Luisa
Grupo de Investigación en Políticas de Salud y Servicios Sanitarios, Servicio de Estudios y Prospectivas en Políticas de Salud, Consorcio de Salud y Social de Cataluña, Barcelona, España.
Grupo de Investigación en Políticas de Salud y Servicios Sanitarios, Servicio de Estudios y Prospectivas en Políticas de Salud, Consorcio de Salud y Social de Cataluña, Barcelona, España.
Gac Sanit. 2019 Jan-Feb;33(1):66-73. doi: 10.1016/j.gaceta.2017.06.001. Epub 2017 Aug 26.
To analyse doctors' opinions on clinical coordination between primary and secondary care in different healthcare networks and on the factors influencing it.
A qualitative descriptive-interpretative study was conducted, based on semi-structured interviews. A two-stage theoretical sample was designed: 1) healthcare networks with different management models; 2) primary care and secondary care doctors in each network. Final sample size (n = 50) was reached by saturation. A thematic content analysis was conducted.
In all networks doctors perceived that primary and secondary care given to patients was coordinated in terms of information transfer, consistency and accessibility to SC following a referral. However, some problems emerged, related to difficulties in acceding non-urgent secondary care changes in prescriptions and the inadequacy of some referrals across care levels. Doctors identified the following factors: 1) organizational influencing factors: coordination is facilitated by mechanisms that facilitate information transfer, communication, rapid access and physical proximity that fosters positive attitudes towards collaboration; coordination is hindered by the insufficient time to use mechanisms, unshared incentives in prescription and, in two networks, the change in the organizational model; 2) professional factors: clinical skills and attitudes towards coordination.
Although doctors perceive that primary and secondary care is coordinated, they also highlighted problems. Identified factors offer valuable insights on where to direct organizational efforts to improve coordination.
分析医生对不同医疗网络中基层医疗与二级医疗之间临床协调的看法以及影响这种协调的因素。
基于半结构化访谈开展了一项定性描述性解释性研究。设计了一个两阶段的理论样本：1）具有不同管理模式的医疗网络；2）每个网络中的基层医疗医生和二级医疗医生。通过饱和抽样达到最终样本量（n = 50）。进行了主题内容分析。
在所有网络中，医生们认为在信息传递、一致性以及转诊后患者获得二级医疗服务的可及性方面，给予患者的基层医疗和二级医疗是协调的。然而，出现了一些问题，涉及获得非紧急二级医疗服务的困难、处方变更以及不同医疗层级间某些转诊的不充分性。医生们确定了以下因素：1）组织影响因素：促进信息传递、沟通、快速获取以及地理位置相近从而培养合作积极态度的机制有助于协调；使用机制的时间不足、处方方面缺乏共同激励措施以及在两个网络中组织模式的改变阻碍了协调；2）专业因素：临床技能和对协调的态度。
尽管医生们认为基层医疗和二级医疗是协调的，但他们也强调了存在的问题。所确定的因素为指导改善协调的组织工作方向提供了有价值的见解。
