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 Services Research

Amparo-Susana Mogollón-Pérez¹  Pamela Eguiguren²  Fernando Bertolotto³  Isabella Samico⁴  Ingrid Vargas⁵  María-Luisa Vázquez⁵  Julieta López-Vázquez⁶ 

[1] Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cra 24 No. 63C-69, Quinta Mutis, 11001, Bogotá, Colombia;Escuela de Salud Pública Dr. Salvador Allende Gossens, Facultad de Medicina, Universidad de Chile, Avenida Independencia, 939, Santiago de Chile, Chile;Facultad de Enfermería, Universidad de la República, Avenida 18 de Julio 124, 11200, Montevideo, Uruguay;Grupo de Estudos de Gestão e Avaliação em Saúde, Instituto de Medicina Integral Prof. Fernando Figueira, Rua Dos Coelhos No. 300, 50070-550 Recife, Boa Vista, Brazil;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;Instituto de Salud Pública, Universidad Veracruzana, Avenida Dr. Luis Castelazo Ayala s/n. Col. Industrial Ánimas, 91190 Xalapa, Veracruz, Mexico;

关键词: Care coordination;    Care integration;    Integrated delivery systems;    Participatory action research;    Health services research;    Qualitative research;    Implementation science;    Outcomes assessment;    Physicians;    Latin America;   

DOI  :  10.1186/s12913-020-05781-7

来源: Springer

【 摘 要 】

BackgroundFinding 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.MethodsA 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.ResultsInformants 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.ConclusionsEvidence 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.

【 授权许可】

CC BY