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Do existing mechanisms contribute to improvements in care coordination across levels of care in health services networks? Opinions of the health personnel in Colombia and Brazil

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dc.creatorVargas, Ingridspa
dc.creatorMogollón Pérez, Amparo Susana
dc.creatorDe Paepe, Pierrespa
dc.creatorda Silva, Maria Rejane Ferreiraspa
dc.creatorUnger, Jean Pierrespa
dc.creatorVázquez, María-Luisaspa
dc.date.accessioned2020-05-26T00:03:06Z
dc.date.available2020-05-26T00:03:06Z
dc.date.created2015spa
dc.description.abstractBackground: The fragmentation of healthcare provision has given rise to a wide range of interventions within organizations to improve coordination across levels of care, primarily in high income countries but also in some middle and low-income countries. The aim is to analyze the use of coordination mechanisms in healthcare networks and its implications for the delivery of health care. This is studied from the perspective of health personnel in two countries with different health systems, Colombia and Brazil. Methods: A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in two municipalities in each country. Individual semi-structured interviews were conducted with a three stage theoretical sample of a) health (112) and administrative (66) professionals of different care levels, and b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. Results: The results show that care coordination mechanisms are poorly implemented in general. However, the results are marginally better in certain segments of the Colombian networks analyzed (ambulatory centres with primary and secondary care co-location owned by or tied to the contributory scheme insurers, and public providers of the subsidized scheme); and in the network of the state capital in Brazil. Professionals point to numerous problems in the use of existing mechanisms, such as the insufficient recording of information in referral forms, low frequency and level of participation in shared clinical sessions, low adherence to the few available clinical guidelines and the lack of or inadequate referral of patients by the patient referral centres, particularly in the Brazilian networks. The absence or limited use of care coordination mechanisms leads, according to informants, to the inadequate follow-up of patients, interruptions in care and duplication of tests. Professionals use informal strategies to try to overcome these limitations. Conclusions: The results indicate not only the limited implementation of mechanisms for coordination across care levels, but also a limited use of existing mechanisms in the healthcare networks analyzed. This has a negative impact on coordination, efficiency and quality of care. Organizational changes are required in the networks and healthcare systems to address these problems. © 2015 Vargas et al.; licensee BioMed Central.eng
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.1186/s12913-015-0882-4
dc.identifier.issn14726963
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/23562
dc.language.isoengspa
dc.publisherBioMed Central Ltd.spa
dc.relation.citationIssueNo. 1
dc.relation.citationTitleBMC Health Services Research
dc.relation.citationVolumeVol. 15
dc.relation.ispartofBMC Health Services Research, ISSN:14726963, Vol.15, No.1 (2015)spa
dc.relation.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-84930195586&doi=10.1186%2fs12913-015-0882-4&partnerID=40&md5=acb935d47bf16c117d77984d9417be79spa
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)spa
dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subject.keywordAdultspa
dc.subject.keywordintegratedeng
dc.subject.keywordColombiaspa
dc.subject.keywordCommunity carespa
dc.subject.keywordFemalespa
dc.subject.keywordHealth care personnelspa
dc.subject.keywordHealth personnel attitudespa
dc.subject.keywordHumanspa
dc.subject.keywordIntegrated health care systemspa
dc.subject.keywordMalespa
dc.subject.keywordMiddle agedspa
dc.subject.keywordOrganization and managementspa
dc.subject.keywordPsychologyspa
dc.subject.keywordPublic relationsspa
dc.subject.keywordStatistics and numerical dataspa
dc.subject.keywordTotal quality managementspa
dc.subject.keywordAdultspa
dc.subject.keywordAttitude of health personnelspa
dc.subject.keywordBrazilspa
dc.subject.keywordColombiaspa
dc.subject.keywordCommunity health servicesspa
dc.subject.keywordDelivery of health careeng
dc.subject.keywordEfficiencyeng
dc.subject.keywordFemalespa
dc.subject.keywordHealth personnelspa
dc.subject.keywordHumansspa
dc.subject.keywordInterprofessional relationsspa
dc.subject.keywordMalespa
dc.subject.keywordMiddle agedspa
dc.subject.keywordQuality improvementspa
dc.subject.keywordBrazilspa
dc.subject.keywordCare coordination mechanismsspa
dc.subject.keywordCare integrationspa
dc.subject.keywordColombiaspa
dc.subject.keywordHealth personnel's viewsspa
dc.subject.keywordIntegrated delivery systemsspa
dc.subject.keywordIntegrated healthcare networksspa
dc.subject.keywordPatient referral systemsspa
dc.subject.keywordQualitative researchspa
dc.subject.keywordReferral lettersspa
dc.titleDo existing mechanisms contribute to improvements in care coordination across levels of care in health services networks? Opinions of the health personnel in Colombia and Brazilspa
dc.typearticleeng
dc.type.hasVersioninfo:eu-repo/semantics/publishedVersion
dc.type.spaArtículospa
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