Changes in knowledge and use of clinical coordination mechanisms between care levels in healthcare networks of Colombia

Abstract

Clinical coordination mechanisms (CCMs) have become key tools in healthcare networks for improving coordination between primary care (PC) and secondary care (SC) and are particularly relevant in health systems with highly fragmented healthcare provision. However, their implementation has been little studied to date in Latin America and particularly in Colombia. This study analyses the level of knowledge and use of CCMs between care levels and their changes between 2015 and 2017 in two public healthcare networks in Bogotá, Colombia. Comparison of two cross-sectional studies based on surveys among PC and SC doctors working in their networks (174 doctors per network/year). The COORDENA questionnaire was used for measuring knowledge concerning CCMs and the frequency of use and difficulties involved in using referral/ reply letters (R/RLs) and hospital discharge reports (HDRs). Descriptive bivariate analysis and Poisson regression models with robust variance were used for analysing differences between networks and years. The results for both networks and years revealed greater knowledge and use of information coordination mechanisms than those regarding clinical management coordination (though their knowledge increased in 2017). Although widely known and used, significant problems regarding infrequent and late receipt of RLs and HDRs in PC as well as the poor quality of their

Evaluating the effectiveness of care coordination interventions designed and implemented through a participatory action research process: Lessons learned from a quasi-experimental study in public healthcare networks in Latin America

“…On a final note, the worse results in Colombia compared to the CN (which were similar to baseline) may be attributable to changes in the municipality that affected the two networks in an uneven way, as the analysis of contextual changes indicates [ 43 ]. During this period, the Bogotá Health Department, following national policy changes [ 44 , 45 ], reorganized its health services network, introducing a number of strategies and clinical care coordination mechanisms such as electronic medical records (EMR), care paths and the co-location of certain specialities in primary care centres and joint clinics [ 46 ]. At the time of study, many of these mechanisms had already been established in the control network, whereas the intervention network encountered several organizational problems at the preliminary introduction stage, which led some health professionals to reject them [ 46 ].…”

“…During this period, the Bogotá Health Department, following national policy changes [ 44 , 45 ], reorganized its health services network, introducing a number of strategies and clinical care coordination mechanisms such as electronic medical records (EMR), care paths and the co-location of certain specialities in primary care centres and joint clinics [ 46 ]. At the time of study, many of these mechanisms had already been established in the control network, whereas the intervention network encountered several organizational problems at the preliminary introduction stage, which led some health professionals to reject them [ 46 ]. The effects of the intervention may therefore have been obscured in part by these contextual changes and their favourable effects on care coordination in the control network.…”

Implementing joint training sessions of general practitioners and specialists aimed at improving clinical coordination in Colombia: Contributions from participatory action research

“…23 Available evidence suggests that while there has been greater use of feedback mechanisms to improve clinical information coordination in Colombia, there remain problems concerning the quality of the information being shared and the limited use of standardisation mechanisms. 6,24,25 In this paper we report an analysis of the contribution of participatory action research (PAR) in designing and implementing joint training sessions as a means to improve clinical coordination in a public health care network of Bogotá (Colombia) from stakeholders' perspectives.…”

Relational Continuity of Chronic Patients with Primary and Secondary Care Doctors: A Study of Public Healthcare Networks of Six Latin American Countries

“…These problems are particularly pertinent in the case of patients with chronic conditions, who require care over long periods of time from various health services and professionals. They are therefore the most acutely affected by coordination problems across different levels of care, such as deficiencies in the transfer of clinical information between levels or disagreements over the clinical management of the patient [ 1 , 2 ].…”