Granadillo Emily, Romero-Sandoval Adriana, Cisneros-Caceres Maria Jose, Montalvo-Yepez Jose, Gómez-Urrego Guillermo, Barbosa Carolina, Barreto de Oliveira Ana Luiza, Pinheiro Gabriela Pimentel, Bachmann Max, Cruz Alvaro, Cooper Philip, Ferreira Rejane, Romero-Sandoval Natalia Cristina
School of Medicine, Universidad Internacional del Ecuador, Quito, Pichincha, Ecuador.
School of Basic Sciences, Universidad Internacional del Ecuador, Quito, Pichincha, Ecuador.
BMJ Open. 2024 Dec 3;14(12):e084803. doi: 10.1136/bmjopen-2024-084803.
This study explored the attributes of asthma care coordination from the perspective of healthcare professionals at different levels of care in Ecuador.
Qualitative descriptive study. The Integrated Health Networks Model was the theoretical framework of reference. Narrative analysis was used to identify significant phrases from the interviews.
Healthcare professionals involved in the care of patients with asthma in primary care, specialists, emergency and management in three Ecuadorian cities between 2019 and 2021.
25 healthcare professionals participated in semistructured in-depth interviews. Convenience sampling was used.
Participants highlighted the scarce use of institutional documents for the referral of asthma patients from the first level to specialists and vice versa, duplication of tests and medical prescriptions, and lack of appointment availability that limits access to specialised care. From the first level, they considered that specialists do not return patients and specialists stressed that the first level does not have enough training to follow asthma patients. Managers highlighted the system's inability to assign appointments on time and failures in administrative processes for follow-up. Emergency professionals did not have access to the medical records of patients suffering from asthma attacks.
The lack of shared objectives and effective communication between different levels of care for the follow-up of asthma patients were attributes of asthma care coordination perceived by healthcare professionals at different levels of care in Ecuador. The Ecuadorian health system should consider these to improve its performance.
本研究从厄瓜多尔不同医疗层面的医护人员视角，探讨哮喘护理协调的特点。
定性描述性研究。综合健康网络模型为理论参考框架。采用叙事分析从访谈中识别重要短语。
2019年至2021年期间，厄瓜多尔三个城市参与哮喘患者护理的基层医疗、专科、急诊和管理人员。
25名医护人员参与了半结构化深度访谈。采用便利抽样。
参与者强调，机构文件在将哮喘患者从基层转诊至专科医生或反之过程中使用不足，检查和医疗处方存在重复，且预约难限制了患者获得专科护理的机会。从基层来看，他们认为专科医生不将患者转回，而专科医生则强调基层没有足够的培训来跟踪哮喘患者。管理人员强调系统无法按时安排预约，以及后续行政流程存在失误。急诊专业人员无法获取哮喘发作患者的病历。
厄瓜多尔不同医疗层面的医护人员认为，哮喘患者随访中不同医疗层面缺乏共同目标和有效沟通是哮喘护理协调的特点。厄瓜多尔卫生系统应考虑这些因素以提高其绩效。
