Reply letter utilization by secondary level specialists in a municipality in Brazil: a qualitative study

Harris, Matthew; Ferreira, Ana Rita; Morães, Isabela; Andrade, Fernanda de; Souza, Daise de

doi:10.1590/s1020-49892007000200005

Cited by 13 publications

(17 citation statements)

References 30 publications

(30 reference statements)

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“…The results show weaknesses in the transfer of clinical information across care levels in the networks analyzed due to insufficient recording of data on the part of health professionals, especially in the transfer from primary care to outpatient secondary care. This is a problem often cited in other studies, mainly carried out in the health systems of high income countries [ 17 , 56 – 59 ] but also in some middle and low-income countries [ 60 , 61 ], and is usually related to the lack of time for recording information [ 56 ]. In the context of this study, in addition to the lack of time, it is related to the lack of willingness to communicate between levels, especially on the part of the secondary care professionals, due to a lack of interest, awareness, appreciation and trust in the role of the primary care level in patient follow-ups [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

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

Vargas

Mogollón-Pérez

Paepe

et al. 2015

BMC Health Serv Res

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BackgroundThe 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.MethodsA 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.ResultsThe 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.ConclusionsThe 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.

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Section: Discussionmentioning

confidence: 99%

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

Vargas

Mogollón-Pérez

Paepe

et al. 2015

BMC Health Serv Res

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“…Whilst for Brazil there are some, the studies tend to be limited—with a few exceptions (Almeida et al 2010 )—to the analysis of just one type of healthcare coordination or the use of a single mechanism (Figueiredo et al 2009 ; Pinto et al 2012 ). Very few of these studies go into greater depth on the factors associated with coordination (Harris et al 2007 ).…”

Section: Introductionmentioning

confidence: 99%

Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil

Vargas

Mogollón-Pérez

Paepe

et al. 2016

Health Policy Plan.

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Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel’ perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive–interpretative study was conducted, based on a case study of healthcare networks in four municipalities. 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. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen the state planning and supervision functions and improve professional working conditions and skills.

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“…Dalam penelitian lain persepsi dokter spesialis atas kemampuan dokter umum menyebabkan pasien tetap dirawat di rumah sakit. 9 Pertimbangan intrapersonal merupakan komponen penting, sikap kurang simpatik seharusnya tidak ada dalam kolaborasi antar profesi. 10 Kekosongan obat yang sering terjadi di apotik dan sikap kurang kooperatif antara dokter spesialis dan apoteker mengakibatkan kendala program rujuk balik.…”

Section: Pembahasanunclassified

Analisis Kolaborasi Antar Profesi Dalam Program Rujuk Balik Bpjs Kesehatan Di Kabupaten Kotawaringin Timur

Sutriso¹,

Setiawati²,

Hilfi³

2017

jsk

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Peningkatan penyakit kronis pada usia lanjut berdampak pada peningkatan pembiayaan kesehatan, termasuk pembiayaan kesehatan yang harus ditanggung oleh BPJS. Sejak tahun 2014 BPJS melaksanakan program rujuk balik sebagai upaya efisiensi biaya kesehatan, namun dalam pelaksanaannya tidak sesuai harapan. Beberapa faktor mempengaruhinya, salah satunya adalah kolaborasi antar profesi. Tujuan penelitian menganalisis kolaborasi antar profesi dalam program rujuk balik BPJS di Kabupaten Kotawaringin Timur. Metode penelitan adalah kualitatif, dengan pendekatan studi kasus, paradigma konstruktivisme. Penelitian dilakukan dengan observasi lapangan dan data pelaksanaan program rujuk balik BPJS di Kabupaten Kotawaringin Timur, serta wawancara. Wawancara mendalam terhadap dua dokter spesialis, dua dokter umum, satu apoteker dan satu pegawai BPJS. Penelitian dilakukan di bulan Januari dan Februari 2017. Data dianalisis secara kualitatif, berdasarkan tema-tema sesuai kerangka pemikiran. Analisis data mendasarkan proposisi teoritis. Hasil penelitian: program rujuk balik BPJS di Kabupaten Kotawaringin Timur tidak mencapai target (< 5 kasus/minggu), kolaborasi antar profesi dalam program rujuk balik kurang berfungsi karena beberapa faktor: pertimbangan sosial dan intrapersonal, lingkungan kerja, intitusi, kelembagaan serta interpersonal, perilaku dan sikap para profesi serta tidak adanya leader atau penengah dalam pelaksanaan kolaborasi antar profesi. Simpulan penelitian ini adalah pelaksanaan kolaborasi antar profesi kurang berfungsi, yang berdampak target Program Rujuk Balik BPJS di Kabupaten Kotawaringin Timur tidak mencapai target.Kata kunci: BPJS Kesehatan, Kolaborasi Antar Profesi, Program Rujuk Balik

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Reply letter utilization by secondary level specialists in a municipality in Brazil: a qualitative study

Cited by 13 publications

References 30 publications

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

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

Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil

Analisis Kolaborasi Antar Profesi Dalam Program Rujuk Balik Bpjs Kesehatan Di Kabupaten Kotawaringin Timur

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