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Shimocomaqui GB, Masuda ET, de Souza VG, Gadelha AKDS, Eshriqui I. Specialized outpatient care for maternal and child health in PlanificaSUS areas. Rev Saude Publica 2024; 57Suppl 3:3s. [PMID: 38629667 PMCID: PMC11037908 DOI: 10.11606/s1518-8787.2023057005336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 11/03/2023] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To describe the organization of specialized outpatient clinics, according to the Secondary Outpatient Care Unit (SOCU) model according to the health care planning (HCP) methodology. METHODS This is a descriptive and cross-sectional study, which used secondary data from the PlanificaSUS project. It was carried out in 16 outpatient clinics specialized in maternal and child care, distributed in the five Brazilian geographic regions. A structured questionnaire was used for self-assessment on the implementation of 12 parameters in two moments, in 2019 and in 2020. These parameters are related to the care, educational, and supervisory functions set out in the SOCU model. RESULTS In 2019, only 37.5% (six) of the outpatient clinics completed at least one parameter related to the care function, most frequently the multiprofessional team with interdisciplinary action (completed in 18.8% of the outpatient clinics). No parameters from the educational and supervisory functions were completed at this initial stage. In 2020, on the other hand, parameters related to the care function also showed higher frequency, higlighting the use of the same criterion by primary care teams and outpatient clinics for risk stratification (completed in 68.8% of the outpatient clinics). In the educational and supervisory functions, parameters related to the encounter between primary care teams and outpatient clinics for case management development, integrated training promotion, and close communication bond among these professionals also increased. Completion of these three parameters was identified in 25%, 25%, and 37.5% of the outpatient clinics, respectively. CONCLUSIONS The planning methodology fostered reflection and discussion about the (re)organization of the work process and contributed to changes in maternal and child health care practices within specialized outpatient care, integrated with primary health care (PHC), from the perspective of care networks. We believe that such advances enhance access and equitable care for high-risk pregnant women and children in different geographical regions of Brazil.
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Affiliation(s)
- Guilherme Barbosa Shimocomaqui
- Hospital Israelita Albert EinsteinCentro de Estudos, Pesquisa e Prática em Atenção Primária à Saúde e RedesSão PauloSPBrasil Hospital Israelita Albert Einstein. Centro de Estudos, Pesquisa e Prática em Atenção Primária à Saúde e Redes. São Paulo, SP, Brasil
| | - Eliana Tiemi Masuda
- Hospital Israelita Albert EinsteinCentro de Estudos, Pesquisa e Prática em Atenção Primária à Saúde e RedesSão PauloSPBrasil Hospital Israelita Albert Einstein. Centro de Estudos, Pesquisa e Prática em Atenção Primária à Saúde e Redes. São Paulo, SP, Brasil
| | - Victoria Gouveia de Souza
- Faculdade de Ciências da Saúde Albert EinsteinPrograma de Graduação em EnfermagemSão PauloSPBrasilFaculdade de Ciências da Saúde Albert Einstein. Programa de Graduação em Enfermagem. São Paulo, SP, Brasil
| | - Ana Karina de Sousa Gadelha
- Hospital Israelita Albert EinsteinCentro de Estudos, Pesquisa e Prática em Atenção Primária à Saúde e RedesSão PauloSPBrasil Hospital Israelita Albert Einstein. Centro de Estudos, Pesquisa e Prática em Atenção Primária à Saúde e Redes. São Paulo, SP, Brasil
| | - Ilana Eshriqui
- Hospital Israelita Albert EinsteinCentro de Estudos, Pesquisa e Prática em Atenção Primária à Saúde e RedesSão PauloSPBrasil Hospital Israelita Albert Einstein. Centro de Estudos, Pesquisa e Prática em Atenção Primária à Saúde e Redes. São Paulo, SP, Brasil
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Vargas I, Mogollón-Pérez AS, Eguiguren P, Samico I, Bertolotto F, López-Vázquez J, Amarilla DI, De Paepe P, Vázquez ML. Lessons learnt from the process of designing care coordination interventions through participatory action research in public healthcare networks of six Latin American countries. Health Res Policy Syst 2023; 21:39. [PMID: 37264416 DOI: 10.1186/s12961-023-00985-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 04/27/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The participation of health professionals in designing interventions is considered vital to effective implementation, yet in areas such as clinical coordination is rarely promoted and evaluated. This study, part of Equity-LA II, aims to analyse the design process of interventions to improve clinical coordination, taking a participatory-action-research (PAR) approach, in healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. This participatory process was planned in four phases, led by a local steering committee (LSC): (1) dissemination of problem analysis results and creation of professionals' platform, (2) selection of problems and intervention (3) intervention design and planning (4) adjustments after evaluation of first implementation stage. METHODS A descriptive qualitative study based on documentary analysis, using a topic guide, was conducted in each intervention network. Documents produced regarding the intervention design process were selected. Thematic content analysis was conducted, generating mixed categories taken from the topic guide and identified from data. Main categories were LSC characteristics, type of design process (phases, participants' roles, methods) and associated difficulties, coordination problems and interventions selected. RESULTS LSCs of similar composition (managers, professionals and researchers) were established, with increasing membership in Chile and high turnover in Argentina, Colombia and Mexico. Following results dissemination and selection of problems and interventions (more participatory in Chile and Colombia: 200-479 participants), the interventions were designed and planned, resulting in three different types of processes: (1) short initial design with adjustments after first implementation stage, in Colombia, Brazil and Mexico; (2) longer, more participatory process, with multiple cycles of action/reflection and pilot tests, in Chile; (3) open-ended design for ongoing adaptation, in Argentina and Uruguay. Professionals' time and the political cycle were the main barriers to participation. The clinical coordination problem selected was limited communication between primary and secondary care doctors. To address it, through discussions guided by context and feasibility criteria, interventions based on mutual feedback were selected. CONCLUSIONS As expected in a flexible PAR process, its rollout differed across countries in participation and PAR cycles. Results show that PAR can help to design interventions adapted to context and offers lessons that can be applied in other contexts.
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Affiliation(s)
- Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo 21, 08022, Barcelona, Spain.
| | - Amparo-Susana Mogollón-Pérez
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cra 24 No. 63C-69, Quinta Mutis, 11001, Bogotá, Colombia
| | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Facultad de Medicina, Universidad de Chile, Avenida Independencia, 939, Santiago de Chile, Chile
| | - Isabella Samico
- Instituto de Medicina Integral Prof. Fernando Figueira-IMIP, Rua Dos Coelhos No. 300, Boa Vista, 50070-550, Recife, Brasil
| | - Fernando Bertolotto
- Facultad de Enfermería, Universidad de la República, Avenida 18 de Julio 124, 11200, Montevideo, Uruguay
| | - Julieta López-Vázquez
- Instituto de Salud Pública, Universidad Veracruzana, Avenida Dr. Luis Castelazo Ayala S/N. Col. Industrial Ánimas, 91190, Xalapa, Veracruz, México
| | - Delia-Inés Amarilla
- Centro de Estudios Interdisciplinarios, Universidad Nacional de Rosario, Rosario, Argentina
| | - Pierre De Paepe
- Public Sector Care Unit, Department of Public Health, Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo 21, 08022, Barcelona, Spain
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Status of breast cancer in Latin American: Results of the breast cancer revealed initiative. Crit Rev Oncol Hematol 2023; 181:103890. [PMID: 36462594 DOI: 10.1016/j.critrevonc.2022.103890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 12/05/2022] Open
Abstract
The Breast Cancer Revealed initiative was designed and conducted to know the status of breast cancer at each point of breast cancer care, through i) prevention, ii) detection, iii) diagnosis, iv) treatment, and iv) the capacity of our health systems. The expert panel from 11 Latin American countries identified several strategies and proposed high impact priorities, including implementation of prevention policies, improve primary healthcare capacity for breast cancer screening, have adequate infrastructure to make effective and timely diagnoses, have a multidisciplinary team in the treatment process, access to a variety of treatments for all types of patients, have a coordinated and articulated system from primary care to specialized hospital. In a region with limited resources, prioritization in high-impact strategies for breast cancer control could lead to improved clinical outcomes and quality of life for our patients.
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Aboelkhir HAB, Elomri A, ElMekkawy TY, Kerbache L, Elakkad MS, Al-Ansari A, Aboumarzouk OM, El Omri A. A Bibliometric Analysis and Visualization of Decision Support Systems for Healthcare Referral Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16952. [PMID: 36554837 PMCID: PMC9778793 DOI: 10.3390/ijerph192416952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/24/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The referral process is an important research focus because of the potential consequences of delays, especially for patients with serious medical conditions that need immediate care, such as those with metastatic cancer. Thus, a systematic literature review of recent and influential manuscripts is critical to understanding the current methods and future directions in order to improve the referral process. METHODS A hybrid bibliometric-structured review was conducted using both quantitative and qualitative methodologies. Searches were conducted of three databases, Web of Science, Scopus, and PubMed, in addition to the references from the eligible papers. The papers were considered to be eligible if they were relevant English articles or reviews that were published from January 2010 to June 2021. The searches were conducted using three groups of keywords, and bibliometric analysis was performed, followed by content analysis. RESULTS A total of 163 papers that were published in impactful journals between January 2010 and June 2021 were selected. These papers were then reviewed, analyzed, and categorized as follows: descriptive analysis (n = 77), cause and effect (n = 12), interventions (n = 50), and quality management (n = 24). Six future research directions were identified. CONCLUSIONS Minimal attention was given to the study of the primary referral of blood cancer cases versus those with solid cancer types, which is a gap that future studies should address. More research is needed in order to optimize the referral process, specifically for suspected hematological cancer patients.
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Affiliation(s)
| | - Adel Elomri
- College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Tarek Y. ElMekkawy
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha 2713, Qatar
| | - Laoucine Kerbache
- College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Mohamed S. Elakkad
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Abdulla Al-Ansari
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Omar M. Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
- College of Medicine, QU-Health, Qatar University, Doha 2713, Qatar
- School of Medicine, Dentistry and Nursing, The University of Glasgow, Glasgow G12 8QQ, UK
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
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Guerra S, Martelli PJDL, Dubeux LS, Marques P, Samico IC. [Coordination of clinical management between levels: the views of physicians in primary and specialized care in Recife, Pernambuco State, Brazil]. CAD SAUDE PUBLICA 2022; 38:e00262921. [PMID: 35649101 DOI: 10.1590/0102-311xpt262921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/15/2022] [Indexed: 11/22/2022] Open
Abstract
This study analyzed the views of physicians towards coordination of clinical management between different levels of care. This was a cross-sectional quantitative study using data from a survey of 182 physicians in primary healthcare (PHC) and specialized care in Recife, Pernambuco State, Brazil, in 2017. The results revealed significant differences in the physicians' experience. Considering referrals, the majority (81.32%) felt that PHC physicians referred patients to specialized care when necessary, and the proportion was higher in PHC physicians themselves (92.73%). As for agreement, two-thirds of PHC physicians (67.27%) reported that they agreed with the treatment prescribed by the specialist, while only 33.86% of the specialists agreed with the PHC physician. Concerning clinical responsibility, 89.09% of PHC physicians reported that they were clinically responsible for the patient, compared to only 43.31% of the specialists. As for recommendations, most of the interviewees (63.19%) felt that the specialists did not issue recommendations, and this proportion was higher among PHC physicians (81.82%). For waiting time, the majority (82.42%) felt that patients waited too long for appointments in specialized care, and the proportion was higher among PHC physicians (98.18%) than among specialists (75.59%). Only 16.36% of PHC physicians felt that waiting time was too long in PHC, compared to 38.58% of the medical specialists. The study's results are consistent with similar studies and highlight the need to strengthen coordination between levels of care to achieve effective integration in healthcare networks.
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Affiliation(s)
- Sofia Guerra
- Grupo de Estudos em Gestão e Avaliação em Saúde, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brasil
| | | | - Luciana Santos Dubeux
- Grupo de Estudos em Gestão e Avaliação em Saúde, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brasil
| | - Pedro Marques
- Grupo de Estudos em Gestão e Avaliação em Saúde, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brasil
| | - Isabella Chagas Samico
- Grupo de Estudos em Gestão e Avaliação em Saúde, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brasil
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León-Arce HG, Chávez Chávez J, Mogollón-Pérez AS, Vargas I, Vázquez ML. Implementing joint training sessions of general practitioners and specialists aimed at improving clinical coordination in Colombia: Contributions from participatory action research. J Health Serv Res Policy 2022; 27:261-268. [PMID: 35603753 DOI: 10.1177/13558196221094676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyse 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 in Bogotá, Colombia. METHODS A qualitative, descriptive-interpretative study using semi-structured individual interviews and focus groups with 40 professionals (GPs, specialists, members of the local steering committee (LSC) and network middle managers) involved in designing and implementing joint training sessions to improve cross-level clinical coordination. The intervention consisted of two forms of joint training sessions for GPs and specialists, implemented through two PAR cycles. RESULTS The PAR approach in designing and implementing joint training sessions led to greater awareness of clinical coordination problems and helped adapting sessions to the local health care context. Study participants highlighted the role of LSC leadership during the PAR process and the importance of ensuring the necessary resources for adopting the intervention. Limited institutional support and differences between joint training sessions affected doctors' participation and reduced the time available to conduct the sessions. The use of a reflexive method was essential in enhancing doctors' participation, along with session duration, the facilitator's role and session content. CONCLUSIONS The study provides evidence regarding the contribution of a PAR process to designing and implementing joint training sessions for improving clinical coordination. The findings can inform similar approaches in other health systems.
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Affiliation(s)
- Heisel G León-Arce
- Junior researcher at the School of Medicine and Health Sciences, 25807Universidad del Rosario, Bogotá, Colombia.,PhD Student, Department of Paediatrics, Obstetrics & Gynaecology and Preventative Medicine, Universitat Autònoma de Barcelona, Spain
| | - Josefina Chávez Chávez
- Junior researcher at the School of Medicine and Health Sciences, 25807Universidad del Rosario, Bogotá, Colombia
| | | | - Ingrid Vargas
- Senior researcher, Health Policy and Health Services Research Group Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - María-Luisa Vázquez
- Head, Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
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Vázquez ML, Miranda-Mendizabal A, Eguiguren P, Mogollón-Pérez AS, Ferreira-de-Medeiros-Mendes M, López-Vázquez J, Bertolotto F, Vargas I. 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. PLoS One 2022; 17:e0261604. [PMID: 35020735 PMCID: PMC8754346 DOI: 10.1371/journal.pone.0261604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/06/2021] [Indexed: 11/27/2022] Open
Abstract
Background Despite increasing recommendations for health professionals to participate in intervention design and implementation to effect changes in clinical practice, little is known about this strategy’s effectiveness. This study analyses the effectiveness of interventions designed and implemented through participatory action research (PAR) processes in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay to improve clinical coordination across care levels, and offers recommendations for future research. Methods The study was quasi-experimental. Two comparable networks, one intervention (IN) and one control (CN), were selected in each country. Baseline (2015) and evaluation (2017) surveys of a sample of primary and secondary care doctors (174 doctors/network/year) were conducted using the COORDENA® questionnaire. Most of the interventions chosen were based on joint meetings, promoting cross-level clinical agreement and communication for patient follow-up. Outcome variables were: a) intermediate: interactional and organizational factors; b) distal: experience of cross-level clinical information coordination, of clinical management coordination and general perception of coordination between levels. Poisson regression models were estimated. Results A statistically significant increase in some of the interactional factors (intermediate outcomes) -knowing each other personally and mutual trust- was observed in Brazil and Chile INs; and in some organizational factors -institutional support- in Colombia and Mexico. Compared to CNs in 2017, INs of Brazil, Chile, Colombia and Mexico showed significant differences in some factors. In distal outcomes, care consistency items improved in Brazil, Colombia and Uruguay INs; and patient follow-up improved in Chile and Mexico. General perception of clinical coordination increased in Brazil, Colombia and Mexico INs. Compared to CNs in 2017, only Brazil showed significant differences. Conclusions Although more research is needed, results show that PAR-based interventions improved some outcomes regarding clinical coordination at network level, with differences between countries. However, a PAR process is, by definition, slow and gradual, and longer implementation periods are needed to achieve greater penetration and quantifiable changes. The participatory and flexible nature of interventions developed through PAR processes poses methodological challenges (such as defining outcomes or allocating individuals to different groups in advance), and requires a comprehensive mixed-methods approach that simultaneously evaluates effectiveness and the implementation process to better understand its outcomes.
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Affiliation(s)
- María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - Andrea Miranda-Mendizabal
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
- School of Medicine and Health Sciences, International University of Catalonia (UIC), Sant Cugat del Vallès, Spain
| | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | | | | | | | | | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
- * E-mail:
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Turner S, Segura C, Niño N. Implementing COVID-19 Surveillance Through Inter-Organizational Coordination: A Qualitative Study of Three Cities in Colombia. Health Policy Plan 2021; 37:232-242. [PMID: 34875065 PMCID: PMC8689710 DOI: 10.1093/heapol/czab145] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 10/15/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
Introducing comprehensive surveillance is recommended as an urgent public health measure to control and mitigate the spread of coronavirus disease 2019 (COVID-19) worldwide. However, its implementation has proven challenging as it requires inter-organizational coordination among multiple healthcare stakeholders. The purpose of this study was to examine the role of soft and hard mechanisms in the implementation of inter-organizational coordination strategies for COVID-19 surveillance within Colombia, drawing on evidence from the cities of Bogotá, Cali and Cartagena. The study used a case study approach to understand the perspectives of local and national authorities, insurance companies and health providers in the implementation of inter-organizational coordination strategies for COVID-19 surveillance. Eighty-one semi-structured interviews were conducted between June and November 2020. The data were analysed by codes and categorized using New NVivo software. The study identified inter-organizational coordination strategies that were implemented to provide COVID-19 surveillance in the three cities. Both soft (e.g. trust and shared purpose) and hard mechanisms (e.g. formal agreements and regulations) acted as mediators for collaboration and helped to address existing structural barriers in the provision of health services. The findings suggest that soft and hard mechanisms contributed to promoting change among healthcare system stakeholders and improved inter-organizational coordination for disease surveillance. The findings contribute to evidence regarding practices to improve coordinated surveillance of disease, including the roles of new forms of financing and contracting between insurers and public and private health service providers, logistics regarding early diagnosis in infectious disease and the provision of health services at the community level regardless of insurance affiliation. Our research provides evidence to improve disease surveillance frameworks in fragmented health systems contributing to public health planning and health system improvement.
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Affiliation(s)
- Simon Turner
- School of Management, University of los Andes, Bogotá, Colombia
| | - Carolina Segura
- School of Management, University of los Andes, Bogotá, Colombia
| | - Natalia Niño
- School of Medicine, University of los Andes, Bogotá, Colombia
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López-Vázquez J, Pérez-Martínez DE, Vargas I, Vázquez ML. Interventions to Improve Clinical Coordination between Levels: Participatory Experience in a Public Healthcare Network in Xalapa, Mexico. Int J Integr Care 2021; 21:12. [PMID: 34785996 PMCID: PMC8570199 DOI: 10.5334/ijic.5892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 10/14/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Coordination of care can be improved through an intervention or a combination of several ones. In addition, it is recommended to encourage the active involvement of professionals in the design, implementation and assessment of coordination mechanisms. OBJECTIVE To analyse the factors that influence the implementation of participatively designed interventions and their effects on clinical coordination between levels of care in a public healthcare network of health services in Xalapa, Veracruz, Mexico. METHODS A qualitative, descriptive-interpretative study, for which individual interviews and discussion groups with a criterion sample of participants: Local Steering Committee and the Professional Platform. A content analysis, with mixed category generation and segmentation by intervention and topics, was carried out. According to the problem analysis, participants designed two sequential interventions: offline virtual consultation, and joint training meetings on maternal health and chronic diseases. RESULTS Respondents perceived a differentiated impact on clinical coordination according to intervention: greater in the case of joint maternal health trainings and limited for the chronic diseases meetings, as they were the offline virtual consultation was rarely used. CONCLUSION The involvement of professionals in designing the interventions, as well as institutional support and reflexive methods for training, all decisively improved clinical coordination between levels.
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Affiliation(s)
- Julieta López-Vázquez
- Instituto de Salud Pública, Universidad Veracruzana, Av. Dr. Luis Castelazo Ayala s/n. Col. Industrial Ánimas, 91190 Xalapa, Veracruz, México
- Departamento de Pediatría, de Obstetricia y Ginecología, y de Medicina Preventiva, Universidad Autónoma de Barcelona, Bellaterra (Cerdanyola del Vallés) 08193 Barcelona, España
| | - Damián-Eduardo Pérez-Martínez
- Instituto de Salud Pública, Universidad Veracruzana, Av. Dr. Luis Castelazo Ayala s/n. Col. Industrial Ánimas, 91190 Xalapa, Veracruz, México
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, 08022 Barcelona, Spain
| | - María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, 08022 Barcelona, Spain
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[Virtual consultations in Traumatology and Orthopaedic Surgery]. Semergen 2021; 47:305-314. [PMID: 34112593 DOI: 10.1016/j.semerg.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 01/30/2021] [Accepted: 03/17/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of this study is to analyse the current system of virtual consultations between the levels of Primary and Specialised Care in the field of Traumatology and Orthopaedic Surgery (TOS) in our healthcare area. MATERIAL AND METHOD A retrospective observational study was carried out on 90 consecutive patients who had a non-face-to-face consultation between 3 January 2017 and 10 February 2017 and subsequently a face-to-face consultation. All the patients belonged to the same healthcare area attached to the Nuestra Señora de Candelaria University Hospital. The data on the diagnostic orientation, medical history provided and complementary tests were evaluated by 2 observers, one with training in Family and Community Medicine and the other with specialised training in TOS, and compared with those obtained in the final face-to-face assessment. RESULTS The results showed a low inter-judge agreement regarding the diagnostic orientation, anamnesis, exploration and complementary tests provided in the virtual consultation request. It was considered that only 59% for one observer (Family and Community Medicine) and 47.7% for the other (specialised care) had sufficient information for decision-making. Furthermore, 35.2% required more than one face-to-face assessment consultation until diagnosis and in 45.5% it was necessary to request new complementary tests. In 30.7%, there was no concordance in the suggested and final diagnosis. In 51.9%, no therapeutic action other than that carried out by Primary Care was carried out and 34.1% of the patients were referred to the Rehabilitation department. CONCLUSIONS The current model of virtual consultations in TOS does not seem adequate to respond to this new healthcare model. The number of unnecessary referrals is very high despite the previous virtual assessment by a specialist in TOS. The Family and Community Medicine specialist should have more diagnostic resources and coordination between Primary and Specialised Care is necessary to determine, in the area of TOS, the type of consultations and conditions for which this system should be implemented to obtain adequate coordination and improve communication between both levels of care.
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Mendes LDS, Almeida PFD, Santos AMD, Samico IC, Porto JP, Vázquez ML. Experience with coordination of care between primary care physicians and specialists and related factors. CAD SAUDE PUBLICA 2021; 37:e00149520. [PMID: 34008786 DOI: 10.1590/0102-311x00149520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/20/2020] [Indexed: 11/21/2022] Open
Abstract
The article analyzes the coordination of information and clinical management between levels of care in physicians' experience and explores related labor and organizational factors and attitudes towards the work and interaction. This is a cross-sectional study with application of the COORDENA-BR questionnaire to a sample of 64 primary health care (PHC) physicians and 56 specialized care (SC) from the public system in a medium-sized Brazilian city. The results show limited linkage of care in the Healthcare Network (RAS), with differences between PHC and SC. There is no exchange of information on diagnosis, treatment, or tests. Physicians in PHC agree more on the treatments prescribed by the specialists than vice versa, but repetition of tests is not frequent. PHC physicians refer patients to SC when necessary. Most medical specialists do not refer patients for follow-up consultations in PHC when necessary and do not give orientation to PHC physicians, who in turn fail to resolve their doubts with SC. Both PHC and specialties report long waiting times for specialist consultations. Temporary employment contracts are more common in PHC. Consultation time was considered too short for coordination between the two. Most physicians do not plan to change jobs, despite their heavy dissatisfaction with wages and work. Physicians do not know each other personally, and specialists do not identify physicians in PHC as the coordinators of care. Policies and measures to guarantee structural conditions to improve access, working conditions, and more favorable mutual adaptation need to be implemented systemically to the set of services in the Brazilian Unified National Health System (SUS).
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Affiliation(s)
- Lívia Dos Santos Mendes
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, Vitória da Conquista, Brasil
| | | | - Adriano Maia Dos Santos
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, Vitória da Conquista, Brasil
| | | | - Jéssica Prates Porto
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, Vitória da Conquista, Brasil
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Millares Martin P. Non-systematic review: Correspondence quality and interoperability between family physicians and hospital clinicians. Int J Clin Pract 2021; 75:e13984. [PMID: 33484081 DOI: 10.1111/ijcp.13984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/03/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Medical correspondence between physicians working in the community and in hospital is paramount to provide continuity of care, but there is no agreement on what constitutes a good quality letter, not even interest by some clinicians on this interface. Information flow could be faster electronically rather than in paper, but is content improving? What defines a good letter? AIM (a) To assess what information should be shared between family doctors and hospital physicians and could it be shared better. (b) To assess the possibility of linking the sections of the letter to SNOMED-CT codes to improve interoperability. RESULTS Authors vary regarding what is to be included in communications, and as they also have different needs among services, it creates a very long list of possible items to consider. Standardised templates with their corresponding SNOMED-CT codes are presented. CONCLUSION Standardised correspondence could improve continuity of care. Appropriately coded it could facilitate the information sharing and the data manipulation required to provide an adequate provision of services among primary care or family physicians and hospitals or secondary care organisations. It could also serve as a tool to assess clinicians' performance.
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López-Vázquez J, Pérez-Martínez DE, Vargas I, Vázquez ML. [Barriers and factors associated with the use of coordination mechanisms between levels of care in Mexico]. CAD SAUDE PUBLICA 2021; 37:e00045620. [PMID: 33886705 DOI: 10.1590/0102-311x00045620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/26/2020] [Indexed: 11/22/2022] Open
Abstract
The aim was to analyze the level and characterize the use of clinical coordination mechanisms between levels of care, and their associated factors, in two public networks of health services in Mexico. A cross-sectional study was carried out using the COORDENA questionnaire to primary and specialized care physicians in the state of Veracruz. Differences were found between networks and levels of care, according to the mechanism. In both, the referral/counter-referral is mostly used to channel the patient to another level, mainly by primary care physicians. A high reception of referrals by specialists was identified, but few counterreferences in primary care. Being a man and recognizing the primary care physician, as responsible for monitoring the patient in his/her healthcare career, were factors associated with the frequent sending of the counter-referral by specialists. The discharge report is used in both networks to send clinical information to the other level, with more sending by specialist doctors, but with less reception in primary care. In both networks, the follow-up to the recommendations of the mechanisms to standardize clinical care was greater by primary care physicians than specialized ones. The use of coordination mechanisms between levels of care is deficient and limited, with greater use of mechanisms to transfer information than for clinical management. The need to implement strategies that consider the participation of professionals is evident, to favor local adaptation, appropriation and improve their use.
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Affiliation(s)
- Julieta López-Vázquez
- Instituto de Salud Pública, Universidad Veracruzana, Xalapa, México.,Departamento de Pediatría, de Obstetricia y Ginecología, y de Medicina Preventiva, Universidad Autónoma de Barcelona, Bellaterra, España
| | | | - Ingrid Vargas
- Grup de Recerca en Politiques de Salut i Serveis Sanitaris, Consorci de Salut i Social de Catalunya, Barcelona, España
| | - María-Luisa Vázquez
- Grup de Recerca en Politiques de Salut i Serveis Sanitaris, Consorci de Salut i Social de Catalunya, Barcelona, España
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Forstner J, Bossert J, Weis A, Litke N, Strassner C, Szecsenyi J, Wensing M. The role of personalised professional relations across care sectors in achieving high continuity of care. BMC FAMILY PRACTICE 2021; 22:72. [PMID: 33849453 PMCID: PMC8045382 DOI: 10.1186/s12875-021-01418-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/17/2021] [Indexed: 12/05/2022]
Abstract
Background High continuity of care has a positive impact on health outcomes, but insight into the mechanisms underlying this impact is limited. Information continuity, on which our study focuses, is especially important when relational continuity is not given, which is often the case at hospital admission or hospital discharge. The aim of this study is to provide insight into the information flows between general practices and hospitals in Germany, and to identify factors associated with these flows of information. Methods This is a qualitative interview study in a purposeful sample of staff from hospitals and general practices (general practitioners, care assistants in general practice, hospital management, hospital physicians, and nursing staff). Interviews were conducted via telephone or face-to-face using a self-developed semi-structured interview guide. Stepwise systematic content analysis was used to structure collected material into themes and sub-themes that related to the study aim. Data was analysed by two researchers in several cycles, alternating between inductive and deductive approaches. Results A total of 49 interviews were conducted. Duration of the interviews varies between 21 and 78 min (mean duration 43 min). Across all groups, more than two thirds of participants were female (n = 34, 69%). The analysis highlighted six interdependent main themes regarding factors that affect information flows between hospitals and general practices: organisational, legal, financial, patient factors, individual characteristics, and emotional & social factors. The latter theme emerged as particularly rich and was therefore divided into four subthemes: appreciation and understanding of the respective other, (intrinsic) motivation, socialisation, and relationships. Organised meetings and events were mentioned as strategies to address emotional and social factors. Conclusions Digitalisation can facilitate information flows between care providers. However, knowing each other and good personal relations remain important for effective collaboration. Cooperation between all stakeholders is needed to aim to achieve continuity of care. Trial registration: DRKS00015183 on DRKS/ Universal Trial Number (UTN): U1111-1218–0992. Date of registration 23/08/2018.
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Affiliation(s)
- Johanna Forstner
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Jasmin Bossert
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Aline Weis
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Nicola Litke
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Cornelia Strassner
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Understanding How to Improve the Use of Clinical Coordination Mechanisms between Primary and Secondary Care Doctors: Clues from Catalonia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063224. [PMID: 33804691 PMCID: PMC8003988 DOI: 10.3390/ijerph18063224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 01/27/2023]
Abstract
Clinical coordination between primary (PC) and secondary care (SC) is a challenge for health systems, and clinical coordination mechanisms (CCM) play an important role in the interface between care levels. It is therefore essential to understand the elements that may hinder their use. This study aims to analyze the level of use of CCM, the difficulties and factors associated with their use, and suggestions for improving clinical coordination. A cross-sectional online survey-based study using the questionnaire COORDENA-CAT was conducted with 3308 PC and SC doctors in the Catalan national health system. Descriptive bivariate analysis and logistic regression models were used. Shared Electronic Medical Records were the most frequently used CCM, especially by PC doctors, and the one that presented most difficulties in use, mostly related to technical problems. Some factors positively associated with frequent use of various CCM were: working full-time in integrated areas, or with local hospitals. Interactional and organizational factors contributed to a greater extent among SC doctors. Suggestions for improving clinical coordination were similar between care levels and related mainly to the improvement of CCM. In an era where management tools are shifting towards technology-based CCM, this study can help to design strategies to improve their effectiveness.
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Almeida HBD, Vanderlei LCDM, Mendes MFDM, Frias PGD. [Communicational relations between healthcare professionals and their influence on coordination of care]. CAD SAUDE PUBLICA 2021; 37:e00022020. [PMID: 33624697 DOI: 10.1590/0102-311x00022020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/11/2020] [Indexed: 11/21/2022] Open
Abstract
The study aims to understand the influence of communicational relations among healthcare professionals in the coordination of care between levels. This is a qualitative study with data from the international multicenter study Equity-LA II, with dialectic hermeneutics as the theoretical reference. The authors listened to the audios from 15 interviews with professionals (7 physicians from primary care and 5 from specialized care, and 3 institutional supporters from primary care) in a municipal network in the Agreste region of the state of Pernambuco, Brazil, in 2016. The mixed categories were submitted to content analysis. The analysis revealed a lack of recognition, by nearly all of the professionals, of primary care as the organizational backbone for care, and the perception of coordination revealed obstacles related to disconnects in establishing dialogical relations. Knowledge of the physician's role in primary care is incomplete, and its praxis is viewed with distrust by specialists, while the reciprocal is not true. There was a visibly non-dialogical interpersonal relationship, based on asymmetric relations reflected in the specialist's authoritarian stance and that of inferiority of primary care physicians. The basis for the communicative action relates to pretensions of validity rather than of power, which is external to language, and impedes the discussion of reasons and arguments. There was little disposition for dialogue and reciprocal recognition between the parties involved, with interdiction of a communicative situation in which there is symmetry of participation. The results revealed communicational weaknesses, thus requiring strategies that allow achieving communicative understanding among the professionals and promoting satisfactory patient follow-up between levels of care.
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Vargas I, Eguiguren P, Mogollón-Pérez AS, Samico I, Bertolotto F, López-Vázquez J, Vázquez ML. Can care coordination across levels be improved through the implementation of participatory action research interventions? Outcomes and conditions for sustaining changes in five Latin American countries. BMC Health Serv Res 2020; 20:941. [PMID: 33046079 PMCID: PMC7552474 DOI: 10.1186/s12913-020-05781-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Finding new strategies for care integration has become a policy priority for many fragmented health systems in Latin America. Although the implementation of interventions through a participatory action research (PAR) approach is considered to be more effective in achieving organizational change, its application is scarce. This study, part of the research project Equity-LA II, aims to analyze the impact of PAR interventions on care coordination across levels, and key aspects for their sustainability and transferability, from the stakeholder viewpoint in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay. Different interventions were designed and implemented through a PAR process to improve communication and clinical agreement between primary care and secondary care doctors: joint meetings to discuss clinical cases and/or training; shared care guidelines; offline virtual consultations; a referral and reply letter; and an induction program. METHODS A qualitative, descriptive-interpretative study was conducted in the healthcare network of each country. Focus groups and semi-structured individual interviews were conducted with a criterion sample of participants: local steering committee (29) and professional platform members (28), other health professionals (49) and managers (28). Thematic content analysis was conducted, segmented by country and type of intervention. RESULTS Informants highlighted that joint meetings based on reflexive methods contributed substantially to improving contextually relevant elements of clinical management coordination - communication in patient follow-up, clinical agreement, appropriateness of referrals - and also administrative coordination. The meetings, alongside the PAR process, also helped to improve interaction between professionals - knowing each other personally and mutual trust - thus fostering willingness to collaborate. The PAR approach, moreover, served to spread awareness of the coordination problems and need for intervention, encouraging greater commitment and interest in participating. No noteworthy contributions were identified in remaining interventions due to low uptake. A necessary condition for the sustainability and replicability was that PAR process had to be used appropriately in a favourable context. CONCLUSIONS Evidence is provided on the substantial contribution of interventions to improving locally relevant clinical coordination elements and professional interaction when implemented through an adequate PAR process (in terms of time, method and participation levels), a necessary condition for their sustainability and replicability.
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Affiliation(s)
- Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo 21, 08022, Barcelona, Spain.
| | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Facultad de Medicina, Universidad de Chile, Avenida Independencia, 939, Santiago de Chile, Chile
| | - Amparo-Susana Mogollón-Pérez
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cra 24 No. 63C-69, Quinta Mutis, 11001, Bogotá, Colombia
| | - Isabella Samico
- Grupo de Estudos de Gestão e Avaliação em Saúde, Instituto de Medicina Integral Prof. Fernando Figueira, Rua Dos Coelhos No. 300, Boa Vista, 50070-550 Recife, Brazil
| | - Fernando Bertolotto
- Facultad de Enfermería, Universidad de la República, Avenida 18 de Julio 124, 11200, Montevideo, Uruguay
| | - Julieta López-Vázquez
- Instituto de Salud Pública, Universidad Veracruzana, Avenida Dr. Luis Castelazo Ayala s/n. Col. Industrial Ánimas, 91190 Xalapa, Veracruz, Mexico
| | - María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo 21, 08022, Barcelona, Spain
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Vargas I, Eguiguren P, Mogollón-Pérez AS, Bertolotto F, Samico I, López J, De Paepe P, Vázquez ML. Understanding the factors influencing the implementation of participatory interventions to improve care coordination. An analytical framework based on an evaluation in Latin America. Health Policy Plan 2020; 35:962-972. [PMID: 32743666 PMCID: PMC7553758 DOI: 10.1093/heapol/czaa066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2020] [Indexed: 12/02/2022] Open
Abstract
Healthcare coordination is considered key to improving care quality. Although participatory action research (PAR) has been used effectively to bridge the gap between evidence and practice in other areas, little is known about the key success factors of its use in healthcare organizations. This article analyses the factors influencing the implementation of PAR interventions to improve clinical coordination from the perspective of actors in public healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay. A qualitative, descriptive-interpretative study was conducted in each country's healthcare network. Focus groups and semi-structured individual interviews were conducted to a criterion sample of: local steering committee (LSC) (29), professional platform (PP) (28), health professionals (49) and managers (28). Thematic content analysis was conducted, segmented by country and themes. The PAR process led by the LSC covered the return of baseline results, selection of problems and interventions and design, implementation and adjustment of the intervention, with PP. Interventions were implemented to improve communication and clinical agreement between primary and secondary care. Results reveal that contextual factors, the PAR process and the intervention's content influenced their implementation, interacting across time. First, institutional support providing necessary resources, and professionals' and managers' willingness to participate, emerge as contextual pivotal factors, influenced by other factors related to: the system (alignment with policy and political cycle), networks (lack of time due to work overload and inadequate working conditions) and individuals (not knowing each other and mutual mistrust). Second, different characteristics of the PAR process have a bearing, in turn, on institutional support and professionals' motivation: participation, flexibility, consensual decision-making, the LSC's leadership and the facilitating role of researchers. Evidence is provided that implementation through an adequate PAR process can become a factor of motivation and cohesion that is crucial to the adoption of care coordination interventions, leading to better results when certain contextual factors converge.
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Affiliation(s)
- Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, 08022 Barcelona, Spain
| | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Facultad de Medicina, Universidad de Chile, Avenida Independencia, 939 Santiago de Chile, Chile
| | - Amparo-Susana Mogollón-Pérez
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cra 24 No. 63C-69, Quinta Mutis, 11001 Bogotá, Colombia
| | - Fernando Bertolotto
- Facultad de Enfermería, Universidad de la República, Avenida 18 de Julio 124, 11200 Montevideo, Uruguay
| | - Isabella Samico
- Grupo de Estudos de Gestão e Avaliação em Saúde, Instituto de Medicina Integral Prof. Fernando Figueira, Rua Dos Coelhos No. 300, Boa Vista, 50070-550 Recife, Brasil
| | - Julieta López
- Instituto de Salud Pública, Universidad Veracruzana, Av. Dr. Luis Castelazo Ayala s/n. Col. Industrial Ánimas, 91190 Xalapa, Veracruz, México
| | - Pierre De Paepe
- Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerpen, Belgium
| | - María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, 08022 Barcelona, Spain
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León-Arce HG, Mogollón-Pérez AS, Vargas I, Vázquez ML. Changes in knowledge and use of clinical coordination mechanisms between care levels in healthcare networks of Colombia. Int J Health Plann Manage 2020; 36:134-150. [PMID: 32954542 DOI: 10.1002/hpm.3073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/10/2020] [Accepted: 09/02/2020] [Indexed: 11/11/2022] Open
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 contents limits their effective use, which may affect the quality of care. Strategies are required to improve CCMs use.
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Affiliation(s)
- Heisel Gloria León-Arce
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.,Departamento de Pediatría, de Obstetricia y Ginecología y de Medicina Preventiva, Universidad Autónoma de Barcelona, Barcelona, España
| | | | - Ingrid Vargas
- Servei d'Estudis i Prospectives en Polítiques de Salut, Grup de Recerca en Polítiques de, Salut i Serveis Sanitaris (GRPSS), Consorci de Salut i Social de Catalunya, Barcelona, Spain
| | - María-Luisa Vázquez
- Servei d'Estudis i Prospectives en Polítiques de Salut, Grup de Recerca en Polítiques de, Salut i Serveis Sanitaris (GRPSS), Consorci de Salut i Social de Catalunya, Barcelona, Spain
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Competencies to promote collaboration between primary and secondary care doctors: an integrative review. BMC FAMILY PRACTICE 2020; 21:179. [PMID: 32878620 PMCID: PMC7469099 DOI: 10.1186/s12875-020-01234-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 07/29/2020] [Indexed: 12/02/2022]
Abstract
Background In a society where ageing of the population and the increasing prevalence of long-term conditions are major issues, collaboration between primary and secondary care is essential to provide continuous, patient-centred care. Doctors play an essential role at the primary-secondary care interface in realising ‘seamless’ care. Therefore, they should possess collaborative competencies. However, knowledge about these collaborative competencies is scarce. In this review we explore what competencies doctors need to promote collaboration between doctors at the primary-secondary care interface. Methods We conducted an integrative literature review. After a systematic search 44 articles were included in the review. They were analysed using a thematic analysis approach. Results We identified six themes regarding collaborative competencies: ‘patient-centred care: a common concern’, ‘roles and responsibilities’, ‘mutual knowledge and understanding’, ‘collaborative attitude and respect’, ‘communication’ and ‘leadership’. In every theme we specified components of knowledge, skills and attitudes as found in the reviewed literature. The results show that doctors play an important role, not only in the way they collaborate in individual patient care, but also in how they help shaping organisational preconditions for collaboration. Conclusions This review provides an integrative view on competencies necessary for collaborative practice at the primary-secondary care interface. They are part of several domains, showing the complexity of collaboration. The information gathered in this review can support doctors to enhance and learn collaboration in daily practice and can be used in educational programmes in all stages of medical education.
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Ollé-Espluga L, Vargas I, Mogollón-Pérez A, Soares-de-Jesus RPF, Eguiguren P, Cisneros AI, Muruaga MC, Huerta A, Bertolotto F, Vázquez ML. Care continuity across levels of care perceived by patients with chronic conditions in six Latin-American countries. GACETA SANITARIA 2020; 35:411-419. [PMID: 32654876 DOI: 10.1016/j.gaceta.2020.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/17/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse the care continuity across levels of care perceived by patients with chronic conditions in public healthcare networks in six Latin American countries (Argentina, Brazil, Chile, Colombia, Mexico and Uruguay), and to explore associated factors. METHOD Cross-sectional study by means of a survey conducted to a random sample of chronic patients in primary care centres of the study networks (784 per country) using the questionnaire Cuestionario de Continuidad Asistencial Entre Niveles de Atención (CCAENA)©. Patients had at least one chronic condition and had used two levels of care in the 6 months prior to the survey for the same medical condition. Descriptive analysis and multivariable logistic regression were carried out. RESULTS Although there are notable differences between the networks analysed, the results show that chronic patients perceive significant discontinuities in the exchange of clinical information between primary care and secondary care doctors and in access to secondary care following a referral; as well as, to a lesser degree, regarding clinical coherence across levels. Relational continuity with primary care and secondary care doctors and information transfer are positively associated with care continuity across levels; no individual factor is systematically associated with care continuity. CONCLUSIONS Main perceived discontinuities relate to information transfer and access to secondary care after a referral. The study indicates the importance of organisational factors to improve chronic patients' quality of care.
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Affiliation(s)
- Laia Ollé-Espluga
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain; Department of Sociology, University of Graz, Graz, Austria
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain.
| | - Amparo Mogollón-Pérez
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | | | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | | | | | - Adriana Huerta
- Área de Investigación, Secretaría de Salud Pública Municipal, Rosario, Argentina
| | | | - María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
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Miranda-Mendizábal A, Vargas I, Mogollón-Pérez AS, Eguiguren P, Ferreira de Medeiros Mendes M, López J, Bertolotto F, Amarilla D, Vázquez Navarrete ML. Conocimiento y uso de mecanismos de coordinación clínica de servicios de salud de Latinoamérica. GACETA SANITARIA 2020; 34:340-349. [DOI: 10.1016/j.gaceta.2018.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/20/2018] [Accepted: 09/23/2018] [Indexed: 10/27/2022]
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Araujo MCMH, Vanderlei LCDM, Mendes MFDM, Frias PGD. The thinking and acting of health professionals on the coordination between the assistance levels of the health care network. CIENCIA & SAUDE COLETIVA 2020; 26:3359-3370. [PMID: 34378722 DOI: 10.1590/1413-81232021268.04032020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/23/2020] [Indexed: 11/21/2022] Open
Abstract
The study aims to understand the thinking and acting of health professionals about the coordination between levels of care. Qualitative research from an international multicenter study Equity-LA II. Audios were retrieved from eleven interviews of doctors/nurses of two levels of care in Recife, 2014. A content analysis of the theoretical framework of coordination was performed in the light of the hermeneutic approach. Most professionals knew the duties of coordination, without identifying its execution. The primary care physician was not recognized as responsible for the clinic, nor for his role by the specialist physician, while the primary care physician resented it. Failures in the use/completion of reference/counter-reference mechanisms and organizational barriers emerged. The unavailability for the "conversation game" and "fusionality" was evidenced in the lack of recognition of authority in the authoritative character of the primary care physician by that of the specialized, feeling of less value for that and technicist and specialized posture in everyone's practice. The coordination in on professionals' view revealed the "there-to-be-understood" condition that needs to be launched in the "game of comprehension" to build dialogical practices focused on integral care.
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Affiliation(s)
| | | | | | - Paulo Germano de Frias
- Instituto de Medicina Integral Prof. Fernando Figueira. R. dos Coelhos 300, Boa Vista. 50070-550 Recife PE Brasil.
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Cisneros Luján AI, Cinta Loaiza DM, Sánchez Bandala MA, González Rojas V. Percepción sobre la coordinación de la atención: el caso de las redes de servicios de salud de Xalapa y Veracruz, México, en el periodo 2014-2016. ACTA ACUST UNITED AC 2020. [DOI: 10.11144/javeriana.rgps19.pcac] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Una limitada coordinación asistencial impide garantizar una atención integrada, eficiente y de calidad. El objetivo del estudio fue explorar la percepción de profesionales de salud sobre la coordinación entre niveles de atención y los factores que la influyen. Se realizó un estudio cualitativo mediante el análisis de contenido de 54 entrevistas semiestructuradas y 11 grupos focales con personal de dos redes de servicios de salud en Xalapa y Veracruz, México. Los entrevistados refirieron dificultades para el seguimiento de los pacientes, desacuerdos respecto a los criterios de referencia, barreras de acceso a la atención especializada, baja calidad de los formatos de referencia, escasa recepción de los formatos de contrarreferencia y dificultades para seguir los circuitos de referencia. Atribuyeron estos problemas a la insuficiencia de recursos, la cobertura limitada del Seguro Popular, la sobrecarga de trabajo, falta de supervisión, deficiente formación de los médicos generales y limitada comunicación entre profesionales. Estos resultados coinciden con otros estudios en la región, por lo que se señala la necesidad de reforzar los mecanismos basados en la normalización, introducir estrategias basadas en la adaptación mutua y modificar rasgos de la estructura y cultura organizacional para lograr una coordinación de la atención efectiva, que contribuya a la integración de las redes.
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Gallego-Ardila AD, Pinzón-Rondón ÁM, Mogollón-Pérez AS, Cardozo CX, Vargas I, Vázquez ML. Care coordination in two of Bogota’s public healthcare networks: A cross-sectional study among doctors. INTERNATIONAL JOURNAL OF CARE COORDINATION 2019. [DOI: 10.1177/2053434519892469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Care coordination is a priority concern for healthcare systems. In Colombia, there is a lack of information on the topic. This study analysed how doctors of two Bogotá’s public healthcare networks perceived coordination between healthcare levels and what factors are associated with their perception. Methods A cross-sectional study using the COORDENA-CO questionnaire to a sample of 363 doctors (network-1 = 181; network-2 = 182) in 2015. The questionnaire asks about types and dimensions of care coordination: information and clinical management, with items in a Likert scale, as well as conditions regarding health system, organisational and doctors’ conditions. Descriptive statistics and logistic regression analysis were performed. Results The doctors’ perception of a high level of coordination did not exceed 25.4%. On coordination of information, limited transfer of clinical information was found. Concerning clinical management, there were limited care coherence, deficits in patient follow-up and lengthy waiting times for specialised care. A high perception of coordination were associated with being female, being over 50 years old, being a specialist, having less than one year’s working experience, working less than 20 h per week at the centre, forming part of network-1, having time available for performing coordination tasks, having job satisfaction and not identifying limitations imposed by healthcare insurers. Discussion There was limited perception of coordination, in its different dimensions and types with some differences between networks. The results support the importance of guaranteeing job satisfaction, ensuring sufficient time to coordination-related activities and intervening in the restrictions imposed by healthcare insurers to improve care coordination.
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Cosin-Sales J, Freixa R, Bravo M, Ruvira J, Gràcia PB, Calvo Iglesias FE, Escobar C. Impact of different models of improvement of continuity of care on lipid control and the delay of visits to cardiology. Future Cardiol 2019; 16:33-41. [PMID: 31820660 DOI: 10.2217/fca-2018-0083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: To analyze the impact of implementing three different models of continuity of care on the delay of first visits to the cardiologist (management end point) and on LDL-cholesterol control rates among patients with atherosclerotic vascular disease (clinical end point). Methods: Observational, longitudinal and retrospective study of patients with cardiovascular disease and LDL-cholesterol ≥70 mg/dl attended in three hospitals (H1/H2/H3). In H1 and H2, a virtual system (telecardiology) was developed (in H1, internal audits and specific medical education were also performed). In H3 a cardiologist was integrated into the primary care center. Results: The delay of visits to cardiologist significantly improved from 66.5 ± 29.1 days to 34.1 ± 14.1 days (p < 0.001), as well as the intensification of lipid-lowering treatment and the achievement of lipid goals. LDL-cholesterol control rates were higher in H1 and the reduction of the delay of visits in H3. Conclusion: Continuity of care is associated with improvements in management and clinical end points.
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Affiliation(s)
| | - Roman Freixa
- Department of Cardiology, Consorci Sanitari Integral, Hospital de Sant JoanDespí Moisès Broggi, Barcelona, Spain.,Catalan Society of Cardiology & the Catalan Society of Family & Community Medicine (CAMFiC) Working Group for coordination between Cardiology & Primary Care, Barcelona, Spain.,Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
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Acker PC, Matheson LN, Sovanna T, Sophearom D, Strehlow MC. Strengthening the emergency referral system in Cambodia for women and children under five: a description of interventions and impact analysis. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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[Factors influencing the use of mechanisms for coordinating healthcare levels in Colombia]. GACETA SANITARIA 2019; 35:177-185. [PMID: 31630926 DOI: 10.1016/j.gaceta.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 06/09/2019] [Accepted: 06/28/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To analyse the factors influencing the use of mechanisms for the clinical coordination of two Colombian public healthcare networks' healthcare levels in Bogotá from the main social actors' perspective. METHOD This was a descriptive-interpretative, qualitative study of two public healthcare networks. Discussion groups and semi-structured interviews were used for collecting information. The approach involved two-stage theoretical sampling of a selection of centres operating at different healthcare levels and a selection of informants, including managers (n=19), healthcare employees (n=23) and administrative staff (n=20). Content analysis involved adopting a mixed method approach for generating categories, segmented by network, informant group and topic. RESULTS Both networks had few mechanisms for enabling the clinical coordination of healthcare levels; information transfer mechanisms predominated and clinical management coordination mechanisms only dealt with maternal-perinatal care. Organisational factor-related complications were found regarding their use: lack of time, staff turnover, administrative use and technological deficiency. Employee/staff-related difficulties were due to lack of interest. These factors directly affected coordination with limited information transfer, patient follow-up and healthcare quality (diagnosis and treatment delays). CONCLUSIONS The results highlighted the limited use of clinical coordination mechanisms in both public healthcare networks studied here, with problems in their use. Changes are required that affect directly organisational factors (time for coordination and working conditions) and professional factors (attitudes towards collaborative work).
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Oliveira CRFD, Samico IC, Mendes MFDM, Vargas I, Vázquez ML. [Awareness and use of mechanism for clinical coordination between levels in two health care networks in Pernambuco State, Brasil]. CAD SAUDE PUBLICA 2019; 35:e00119318. [PMID: 31066777 DOI: 10.1590/0102-311x00119318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/28/2019] [Indexed: 11/22/2022] Open
Abstract
This article assesses awareness and use of mechanisms for clinical coordination between service levels in two health care networks in the Pernambuco State, Brasil. It is a descriptive, cross-sectional, survey-based study. We interviewed 381 doctors from the public primary health care and specialized health care networks in the cities of Caruaru and Recife (Sanitary Districts III and VII). We used a structured questionnaire (COORDENA) in order to assess awareness, frequency and characteristics of the use of the following mechanisms: referral and reply letters, discharge summary, phone and notes (mutual adaptation mechanisms), Health Ministry protocols and joint clinical sessions (standardization mechanisms). We analyzed the data using simple frequencies, means and percentages. In general, primary health care doctors are more familiar with the mechanisms, and use them more frequently, than specialized health care doctors. In the comparison between networks, Recife had better results. Referral and reply letters were the most used (61.4%) and joint clinical sessions were the least used (8.6%), in addition to the existence of informal mechanisms (phone 58%, notes 56.6%, WhatsApp 2.6%). Underutilization of mechanisms, divergences in information sent and received between primary health care and specialized health care professionals and inadequate mechanism use suggest communication failures among professionals and service levels. The findings reveal a need for investments that enable awareness, communication and collaboration between professionals, contributing to a better coordination between the different services levels.
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Affiliation(s)
| | | | | | - Ingrid Vargas
- Consorci de Salut i Social de Catalunya, Barcelona, España
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