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.
Escuela de Salud Pública Dr. Salvador Allende Gossens, Universidad de Chile, Independencia 939, Santiago de Chile, Chile.
Int J Environ Res Public Health. 2022 Oct 11;19(20):13008. doi: 10.3390/ijerph192013008.
Despite relational continuity (RC) with the doctor being key to care quality for chronic patients, particularly in fragmented healthcare systems, like many in Latin America (LA), little is known about RC and its attributes, particularly regarding specialists. Aim: We aim to analyse chronic patients' perceptions of RC with primary (PC) and secondary (SC) care doctors, and record changes between 2015 and 2017 in the public healthcare networks of six LA countries. An analysis of two cross-sectional studies applying the CCAENA questionnaire to chronic patients (N = 4881) was conducted in Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay. The dependent variables of RC with PC and SC doctors were: consistency, trust, effective communication, and synthetic indexes based on RC attributes. Descriptive and multivariate analyses were performed. Although the RC index was high in 2015, especially in PC in all countries, and at both levels in Argentina and Uruguay, low perceived consistency of PC and SC doctors in Colombia and Chile and of SC doctors in Mexico revealed important areas for improvement. In 2017 the RC index of SC doctors increased in Chile and Mexico, while SC doctors' consistency in Colombia decreased. This study reveals important gaps in achieving RC with doctors, particularly in SC, which requires further structural and organisational reforms.
尽管与医生的关系连续性（RC）是慢性患者护理质量的关键，特别是在像许多拉丁美洲（LA）国家那样的碎片化医疗体系中，但对于 RC 及其属性，特别是针对专科医生的了解甚少。目的：我们旨在分析慢性患者对初级保健（PC）和二级保健（SC）医生的 RC 感知，并记录六个 LA 国家公共医疗网络中 2015 年至 2017 年之间的变化。我们对应用 CCAENA 问卷的慢性患者（N=4881）进行了两项横断面研究的分析，这些患者来自阿根廷、巴西、智利、哥伦比亚、墨西哥和乌拉圭。RC 与 PC 和 SC 医生的依赖变量为：一致性、信任、有效沟通以及基于 RC 属性的综合指标。进行了描述性和多变量分析。尽管 2015 年 RC 指数较高，尤其是在所有国家的 PC 中，以及在阿根廷和乌拉圭的两个层面上，但在哥伦比亚和智利的 PC 和 SC 医生以及在墨西哥的 SC 医生中，感知到的一致性较低，这揭示了需要改进的重要领域。2017 年，智利和墨西哥的 SC 医生的 RC 指数增加，而哥伦比亚的 SC 医生的一致性下降。这项研究揭示了与医生实现 RC 方面的重要差距，特别是在 SC 方面，这需要进一步的结构和组织改革。
