IntroductionAsthma is a common long-term disorder and strategies to improve asthma control are still a challenge. Integrated delivery of health systems is critical for effective asthma care: there is limited information on experiences of care coordination for asthma from Latin America, especially on perspectives of health personnel and in the context of the COVID-19 pandemic.Methods and analysisThis protocol details a qualitative approach to analyse health workers’ perspectives of healthcare coordination for asthma control during COVID-19 pandemic in Ecuador and Brazil, at primary and specialised levels, through in-depth semistructured interviews using a video communications platform. The analysis will identify knowledge and perspectives based on coordination of clinical information, clinical management and administrative coordination. Theoretical sampling will be used to obtain approximately equal numbers of women and men within each level of healthcare; data saturation will be used to determine sample size. Transcripts will be analysed using content-coding procedures to mark quotations related to major topics and subthemes included in the interview guide, and narrative analysis will be based on a theoretical framework for healthcare coordination to identify new themes and subthemes.Ethics and disseminationEthical approval was obtained from the ethics committees of Hospital General Docente Calderón, Quito, Ecuador; and Universidade Federal da Bahia, Salvador, Brazil. The findings of this study will be disseminated through peer-reviewed articles, conference presentations and condensed summaries for key stakeholders and partners.
Background: Care coordination is a characteristic of integrated health service networks, understood as an action that, based on primary care, integrates the different levels of care. Care coordination can improve the quality of care, especially for chronic diseases such as asthma. Objective: To analyse perspectives of health professionals within different levels of care on the care coordination for asthma in Ecuador. Methods: Descriptive qualitative study. Guided by the Integrated Health Care Network Model, we completed 25 in-depth semi-structured interviews in three Ecuadorian cities between 2020 and 2021. Using purposive sampling, health care professionals were selected from primary, emergency, specialist, and managerial levels. We used narrative analysis to identify significant phrases from interviews. We followed the Standards for Reporting Qualitative Research. Results: Participants highlighted the scarce use of institutional documents for the referral of patients with asthma from the first level to specialists and vice versa, as well as between the different health subsystems. They identified weaknesses in the follow-up for patients with asthma, lack of objectives shared between the different levels of care, duplication of tests and medical prescriptions, and lack of availability of appointments in the public system that limits access to specialized care. The managers highlighted the system's inability to assign appointments on time and failures in administrative processes for follow-up. Emergency professionals do not have access to previous clinical data for patients having an asthma attack, so they rely on the use of emergency treatments without scheduling a specialist referral afterwards. Conclusions: From the perspectives of health professionals in Ecuador, asthma care coordination requires strengthening at all levels within the public health system, from the formulation of common goals to improved transfer of asthmatic patients between levels to optimize healthcare resources.
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