基层和专科医生是否了解和使用协调机制？
Do primary and specialized care physicians know and use coordination mechanisms?
机构信息
Universidade Federal da Bahia. Instituto Multidisciplinar em Saúde. Pós-Graduação em Saúde Coletiva. Vitória da Conquista, BA, Brasil.
Universidade Federal Fluminense. Instituto de Saúde Coletiva. Niterói, RJ, Brasil.
出版信息
Rev Saude Publica. 2020 Nov 23;54:121. doi: 10.11606/s1518-8787.2020054002475. eCollection 2020.
OBJECTIVES
To analyze if primary and specialized care physicians know and use care coordination mechanisms between healthcare levels.
METHODS
Cross-sectional survey study, with the application of the COORDENA-BR instrument to primary and specialized care physicians in a public heathcare network, medium-sized municipality, from June to October 2019. The questionnaire addresses knowledge, frequency of sending and receiving, purpose, characteristics and difficulties in using feedback or mutual adaptation and standardization mechanisms to promote coordination of care service between healthcare levels.
RESULTS
Feedback instruments such as referral and reply letters, hospital discharge report and WhatsApp are widely known by professionals of both levels, without significant differences. Clinical sessions and protocols are not well-known, especially in specialized care, which supposes a low usage of standardization mechanisms to a better coordination between the healthcare levels. Despite being well-known and easy, traditional feedback instruments such as referral and reply letters are not widely used. Fewer physicians knew the protocols, mainly in specialized care. They pointed difficulties in their application, such as insufficient exams and unavailable supplies in the healthcare network. Clinical sessions were unknown and registered low participation frequency. Care overload, low institutionalization and time constraints were barriers identified for the incorporation of care coordination mechanisms in the work process in primary and specialized care, in addition to those related to the provision of health services in the network.
CONCLUSION
We conclude the fragmentation of the system and care can be faced in the complementarity of measures that make it possible to know the mechanisms, develop professional skills, institutionalize and promote organizational conditions for the effective use of coordination mechanisms throughout the healthcare network.
目的
分析初级保健和专科医生是否了解并使用医疗保健水平之间的协调机制。
方法
2019 年 6 月至 10 月，在一个公共卫生网络中，对初级保健和专科医生进行了一项横断面调查研究，并应用了 COORDENA-BR 工具。问卷涉及知识、发送和接收频率、目的、使用反馈或相互适应和标准化机制促进医疗保健水平之间的协调的特点和困难。
结果
反馈工具，如转诊和回复信、住院报告和 WhatsApp，被两个层次的专业人员广泛知晓，没有显著差异。临床会议和方案不太为人所知，特别是在专科护理中，这意味着标准化机制的使用较低，以更好地协调医疗保健水平。尽管反馈工具，如转诊和回复信，是众所周知且易于使用的，但它们并没有被广泛使用。较少的医生知道协议，主要是在专科护理中。他们指出了应用中的困难，例如医疗保健网络中检查不足和供应不足。临床会议是未知的，参与频率较低。在初级保健和专科护理中，工作过程中纳入协调机制的障碍除了与网络中提供卫生服务有关的障碍外，还包括护理负担过重、机构化程度低和时间限制。
结论
我们得出结论，系统和护理的碎片化可以通过采取互补措施来应对，这些措施可以使人们了解机制，发展专业技能，使机构化并为整个医疗保健网络有效使用协调机制创造组织条件。
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