Integrated health care systems for asthma: A qualitative narrative study from the perspective of Ecuadorian health professionals

Abstract

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.