Barreras y facilitadores de la coordinación asistencial en el diagnóstico de cáncer: una visión de los actores involucrados

Abstract

Care coordination is a priority for the improvement of healthcare provision in complex health problems like cancer. The purpose of this study is to analyze the barriers and facilitators of care coordination for the diagnosis of cancer from the perspective of healthcare workers, health managers and administrators of healthcare networks, and public policymakers from Cundinamarca, Colombia. A descriptive-interpretative qualitative study was conducted. Data collection was done through 55 individual semi-structured interviews. Thematic analysis of the content (segmented by network, informant group and theme) was done. The results in both healthcare networks reveal poor care coordination between levels of care for the early diagnosis of cancer, attributed to every institution working independently and the non-existence of effective communication between general practitioners and specialists. Different factors were perceived as barriers for care coordination. Highlighting some related to the health system, such as, the restriction of the provision of care for the benefits plan limited to the level of care the health professional works at, and implementation problems for the integrated routes of healthcare provision directed towards cancer. In relation to health services, participants also described that the models of payment and hiring of healthcare providers by the insurers, lead to fragmented purchase of services and purchase of services outside of the patient’s territory. As well as long waiting times for specialized tests and appointments stablished by health insurers. The barriers related to the healthcare institutions are explained by the participants by the existence of inadequate work/labor conditions and the lack of spaces for shared use of care coordination mechanisms. Finally, health professionals from the lower complexity levels of care, lack the necessary knowledge and experience in the evaluation of ‘red flag’ signs and symptoms for the suspicion of cancer. And specialized professionals lack interest for teamwork with lower levels of care and don’t provide feedback to general physicians. Some facilitators emerged from early screening within health services, as well as follow up and epidemiologic follow-up for patients with the suspicion of cancer. Because of the number of barriers, different strategies are required for the design and implementation of interventions tailored to the improvement of care coordination between levels of care for the early diagnosis of cancer.