Percepción de coordinación entre niveles de atención y sus factores asociados en dos redes públicas de servicios de salud de Bogotá, 2015
Gallego Ardila, Andrés Daniel
Background: Coordination across healthcare levels is a priority for healthcare systems. It represents an intermediate aim for Integrated Healthcare Networks (IHNs) to find quality and efficiency in care provision. In Colombia, it has been little studied. The aim is to analyze the experience of doctors related to coordination across healthcare levels and its related factors in two public IHNs in Bogotá. Methods: A cross-sectional study was carried out applying the COORDENA-CO questionnaire to a sample of 363 primary and secondary care doctors who worked in the study networks (Network-1=181; Network-2=182). Descriptive and multivariate analyses were conducted to assess the relationship between factors and a perception of care coordination. Results: Doctors perceived a limited information’s transfer (Network-1=39.2%; Network-2=48.4%), a poor agreement in treatments prescribed across levels (Network-1=40.9%; Network-2=44.5%), a scarce specialists’ recommendations to primary care (network-1=32.8%; network-2=44.8%) and long waiting times to secondary care (Network-1=14.1%; Network-2=22.7%). Factors associated with a better general perception of coordination were: being a woman (95%CI=1.28-1.70), being older than 50 years old (95%CI=1.13-2.46), being a secondary care doctor (95%CI=1.31-2.70), having an experience lower than a year (95%CI=1.10-4.30), working lesser than 20 hours (95%CI=2.43-2.86), being of the Network-1 (95%CI=1.00-1.38), considering that there is enough time for coordination (95%CI=1.34-1.96), having job satisfaction (95%CI=1.97-3.35), and recognizing that insurers do not limit clinical practice (95%CI=1.09-2.67). Conclusion: There are fails over coordination across levels of care. It requires strategies oriented in aspects such as employment conditions, enough time and control of insurer’s barriers, due to their influence over care coordination.