Health Policy Plan. 2022 Jan 13;37(1):1-11. doi: 10.1093/heapol/czab130.
Although fragmentation in the provision of services is considered an obstacle to effective health care, there is scant evidence on the impact of interventions to improve care coordination between primary care and secondary care in terms of continuity of care-i.e. from the patient perspective-particularly in Latin America (LA). Within the framework of the Equity-LA II project, interventions to improve coordination across care levels were implemented in five Latin American countries (Brazil, Chile, Colombia, Mexico and Uruguay) through a participatory action research (PAR) process. This paper analyses the impact of these PAR interventions on the cross-level continuity of care of chronic patients in public healthcare networks. A quasi-experimental study was performed with measurements based on two surveys of a sample of patients with chronic conditions (392 per network; 800 per country). Both the baseline (2015) and evaluation (2017) surveys were conducted using the CCAENA questionnaire. In each country, two comparable public healthcare networks were selected, one intervention and one control. Outcomes were cross-level continuity of information and clinical management continuity. Descriptive analyses were conducted, and Poisson regression models with robust variance were fitted to estimate changes. With differences between countries, the results showed improvements in cross-level continuity of clinical information (transfer of clinical information) and clinical management continuity (care coherence). These results are consistent with those of previous studies on the effectiveness of the interventions implemented in each country in improving care coordination in Brazil, Chile and Colombia. Differences between countries are probably related to particular contextual factors and events that occurred during the implementation process. This supports the notion that certain context and process factors are needed to improve continuity of care. The results provide evidence that, although the interventions were designed to enhance care coordination and aimed at health professionals, patients report improvements in continuity of care.
尽管服务提供的碎片化被认为是有效医疗保健的障碍，但在初级保健和二级保健之间改善护理协调的干预措施对护理连续性（即从患者角度）的影响方面，几乎没有证据，尤其是在拉丁美洲（LA）。在 Equity-LA II 项目的框架内，通过参与式行动研究（PAR）过程，在五个拉丁美洲国家（巴西、智利、哥伦比亚、墨西哥和乌拉圭）实施了改善跨护理水平协调的干预措施。本文分析了这些 PAR 干预措施对公共医疗保健网络中慢性病患者跨层次护理连续性的影响。一项准实验研究使用基于慢性病患者样本的两项调查进行了测量（每个网络 392 个；每个国家 800 个）。基线（2015 年）和评估（2017 年）调查均使用 CCAENA 问卷进行。在每个国家，选择了两个具有可比性的公共医疗保健网络，一个干预组和一个对照组。结果是信息和临床管理连续性的跨层次连续性。进行了描述性分析，并拟合了具有稳健方差的泊松回归模型来估计变化。由于国家之间存在差异，结果显示在跨层次连续性的临床信息（临床信息转移）和临床管理连续性（护理连贯性）方面有所改善。这些结果与在巴西、智利和哥伦比亚实施的每项干预措施在改善护理协调方面的有效性的先前研究结果一致。国家之间的差异可能与实施过程中发生的特定背景因素和事件有关。这支持了需要某些背景和过程因素来改善护理连续性的观点。研究结果表明，尽管干预措施旨在增强护理协调并针对卫生专业人员，但患者报告护理连续性有所改善。
