IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v182y2017icp10-19.html
   My bibliography  Save this article

Doctors' experience of coordination across care levels and associated factors. A cross-sectional study in public healthcare networks of six Latin American countries

Author

Listed:
  • Vázquez, María-Luisa
  • Vargas, Ingrid
  • Garcia-Subirats, Irene
  • Unger, Jean-Pierre
  • De Paepe, Pierre
  • Mogollón-Pérez, Amparo Susana
  • Samico, Isabella
  • Eguiguren, Pamela
  • Cisneros, Angelica-Ivonne
  • Huerta, Adriana
  • Muruaga, María-Cecilia
  • Bertolotto, Fernando

Abstract

Improving coordination between primary care (PC) and secondary care (SC) has become a policy priority in recent years for many Latin American public health systems looking to reinforce a healthcare model based on PC. However, despite being a longstanding concern, it has scarcely been analyzed in this region. This paper analyses the level of clinical coordination between PC and SC experienced by doctors and explores influencing factors in public healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. A cross-sectional study was carried out based on a survey of doctors working in the study networks (348 doctors per country). The COORDENA questionnaire was applied to measure their experiences of clinical management and information coordination, and their related factors. Descriptive analyses were conducted and a multivariate logistic regression model was generated to assess the relationship between general perception of care coordination and associated factors. With some differences between countries, doctors generally reported limited care coordination, mainly in the transfer of information and communication for the follow-up of patients and access to SC for referred patients, especially in the case of PC doctors and, to a lesser degree, inappropriate clinical referrals and disagreement over treatments, in the case of SC doctors. Factors associated with a better general perception of coordination were: being a SC doctor, considering that there is enough time for coordination within consultation hours, job and salary satisfaction, identifying the PC doctor as the coordinator of patient care across levels, knowing the doctors of the other care level and trusting in their clinical skills. These results provide evidence of problems in the implementation of a primary care-based model that require changes in aspects of employment, organization and interaction between doctors, all key factors for coordination.

Suggested Citation

  • Vázquez, María-Luisa & Vargas, Ingrid & Garcia-Subirats, Irene & Unger, Jean-Pierre & De Paepe, Pierre & Mogollón-Pérez, Amparo Susana & Samico, Isabella & Eguiguren, Pamela & Cisneros, Angelica-Ivonn, 2017. "Doctors' experience of coordination across care levels and associated factors. A cross-sectional study in public healthcare networks of six Latin American countries," Social Science & Medicine, Elsevier, vol. 182(C), pages 10-19.
  • Handle: RePEc:eee:socmed:v:182:y:2017:i:c:p:10-19
    DOI: 10.1016/j.socscimed.2017.04.001
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953617302241
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2017.04.001?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Garcia-Subirats, Irene & Vargas, Ingrid & Mogollón-Pérez, Amparo Susana & De Paepe, Pierre & da Silva, Maria Rejane Ferreira & Unger, Jean Pierre & Vázquez, María Luisa, 2014. "Barriers in access to healthcare in countries with different health systems. A cross-sectional study in municipalities of central Colombia and north-eastern Brazil," Social Science & Medicine, Elsevier, vol. 106(C), pages 204-213.
    2. Londono, Juan-Luis & Frenk, Julio, 1997. "Structured pluralism: towards an innovative model for health system reform in Latin America," Health Policy, Elsevier, vol. 41(1), pages 1-36, July.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Kutzin, Joseph, 2001. "A descriptive framework for country-level analysis of health care financing arrangements," Health Policy, Elsevier, vol. 56(3), pages 171-204, June.
    2. Alipio, Mark, 2020. "A Path Analysis Examining the Relationship Between Access Barriers to Health Services and Healthcare Utilization Among the Publicly Insured: Insights from a Multiprovince Survey in the Philippines," SocArXiv d6vbm, Center for Open Science.
    3. Ramiro Guerrero & Sergio I. Prada & Dov Chernichovsky, 2014. "La doble descentralización en el sector salud: evaluación y alternativas de política pública," Cuadernos de Fedesarrollo 12019, Fedesarrollo.
    4. Bhalotra, Sonia & Fernandez, Manuel, 2021. "The Right to Health and the Health Effects of Denials," The Warwick Economics Research Paper Series (TWERPS) 1376, University of Warwick, Department of Economics.
    5. Sandoval Moreno, Carlos, 2019. "Three essays on poverty measurement and risk protection," Other publications TiSEM 934c114b-7dce-431b-a613-a, Tilburg University, School of Economics and Management.
    6. World Bank, 2005. "Azerbaijan : Health Sector Review Note, Volume 1, Main Report," World Bank Publications - Reports 8692, The World Bank Group.
    7. Cucunubá, Zulma M. & Manne-Goehler, Jennifer M. & Díaz, Diana & Nouvellet, Pierre & Bernal, Oscar & Marchiol, Andrea & Basáñez, María-Gloria & Conteh, Lesong, 2017. "How universal is coverage and access to diagnosis and treatment for Chagas disease in Colombia? A health systems analysis," Social Science & Medicine, Elsevier, vol. 175(C), pages 187-198.
    8. Jorge Iván González, 2016. "Sentimientos y racionalidad en economía," Books, Universidad Externado de Colombia, Facultad de Economía, edition 1, number 75, August.
    9. Verónica Espinel-Flores & Gabriela Tiburcio-Lara & Ingrid Vargas & Pamela Eguiguren & Amparo-Susana Mogollón-Pérez & Marina Ferreira-de-Medeiros-Mendes & Julieta López-Vázquez & Fernando Bertolotto & , 2022. "Relational Continuity of Chronic Patients with Primary and Secondary Care Doctors: A Study of Public Healthcare Networks of Six Latin American Countries," IJERPH, MDPI, vol. 19(20), pages 1-13, October.
    10. César A. Macías-Chapula, 2002. "Bibliometric and webometric analysis of health system reforms in Latin America and the Caribbean," Scientometrics, Springer;Akadémiai Kiadó, vol. 53(3), pages 407-427, March.
    11. Ewig, Christina & Bello, Amparo Hernández, 2009. "Gender equity and health sector reform in Colombia: Mixed state-market model yields mixed results," Social Science & Medicine, Elsevier, vol. 68(6), pages 1145-1152, March.
    12. Klein, Alexander & Crafts, Nicholas, 2023. "Unconditional Convergence in Manufacturing Productivity across U.S. States: What the Long-Run Data Show," CEPR Discussion Papers 18065, C.E.P.R. Discussion Papers.
    13. Alejandro Gaviria & Carlos Medina & Carolina Mejía, 2006. "Evaluating The Impact Of Health Care Reform In Colombia: From Theory To Practice," Documentos CEDE 2647, Universidad de los Andes, Facultad de Economía, CEDE.
    14. Gonzalez Block, Miguel Angel, 1997. "Comparative research and analysis methods for shared learning from health system reforms," Health Policy, Elsevier, vol. 42(3), pages 187-209, December.
    15. Mayer, David, 2000. "On the Role of Health in the Economic and Demographic Dynamics of Brazil, 1980-1995," Arbetsrapport 2000:4, Institute for Futures Studies.
    16. Cavagnero, Eleonora, 2008. "Health sector reforms in Argentina and the performance of the health financing system," Health Policy, Elsevier, vol. 88(1), pages 88-99, October.
    17. Abadia, Cesar Ernesto & Oviedo, Diana G., 2009. "Bureaucratic Itineraries in Colombia. A theoretical and methodological tool to assess managed-care health care systems," Social Science & Medicine, Elsevier, vol. 68(6), pages 1153-1160, March.
    18. Mohammad Hajizadeh & Hong Nghiem, 2011. "Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments?," International Journal of Health Economics and Management, Springer, vol. 11(4), pages 267-285, December.
    19. Jorge Iván González, 2003. "Juan Luis Londoño: ideas para la acción," Revista de Economía Institucional, Universidad Externado de Colombia - Facultad de Economía, vol. 5(8), pages 223-239, January-J.
    20. Andrés Camilo Santos Ospina & Mario García Molina & Liliana Chicaíza Becerra, 2016. "¿Crisis financiera o de gestión? Evolución del sector salud desde la perspectiva de los entes territoriales," Apuntes del Cenes, Universidad Pedagógica y Tecnológica de Colombia, vol. 35(61), pages 177-206, January.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:182:y:2017:i:c:p:10-19. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.