کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
5046526 1475987 2017 10 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Doctors' experience of coordination across care levels and associated factors. A cross-sectional study in public healthcare networks of six Latin American countries
ترجمه فارسی عنوان
تجربه پزشکان در هماهنگی در سطح مراقبت و عوامل مرتبط. یک مطالعه مقطعی در شبکه های بهداشت عمومی در شش کشور آمریکای لاتین
کلمات کلیدی
آمریکای لاتین، هماهنگی مراقبت، یکپارچه سازی مراقبت، سیستم های تحویل یکپارچه، مراقبتهای بهداشتی، مراقبت های بهداشتی اولیه، کیفیت مراقبت های بهداشتی، تحقیقات خدمات بهداشتی،
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی سیاست های بهداشت و سلامت عمومی
چکیده انگلیسی


- First comparative analysis of doctor care coordination experience in Latin America.
- Limited information transfer and communication across care levels in all countries.
- Disagreement over treatments and inappropriate referrals mainly in Chile and Mexico.
- Limited overall coordination across levels mainly in Brazil, Chile and Mexico.
- Associated factors: identifying PC doctor as care coordinator, knowledge and trust.

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.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Social Science & Medicine - Volume 182, June 2017, Pages 10-19
نویسندگان
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