6641b6fcb6bef66e82ceba071ef6497b 255415.pdf 34860d9296ef79b1830f99b0656e5b9504271ceb 255415.pdf 674e4ea01c98a1c1f1866ec28f6eb71c1784ac74f10f6fa44f1d8fe02a34b546 255415.pdf Title: Understanding How to Improve the Use of Clinical Coordination Mechanisms between Primary and Secondary Care Doctors: Clues from Catalonia Subject: 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. Keywords: clinical coordination; coordination mechanisms; primary care; secondary care; electronic medical record; remote consultation; health services research; questionnaire Author: Laura Esteve-Matalí, Ingrid Vargas, Franco Amigo, Pere Plaja, Francesc Cots, Erick F. Mayer, Joan-Manuel Pérez-Castejón and María-Luisa Vázquez Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Sat Mar 20 08:57:16 2021 CET ModDate: Sat Mar 20 09:01:22 2021 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 18 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1626872 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- APWKLL+VnURWPalladioL Type 1 Custom yes yes no 10 0 QHAZEL+URWPalladioL-Ital Type 1 Custom yes yes no 15 0 ODORCH+URWPalladioL-Bold Type 1 Custom yes yes no 20 0 YVRUPI+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 JYPLJJ+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 LWQXII+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 36 0 IRWHZX+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 39 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 61 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 65 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 69 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes no 87 0 NCAACO+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 123 0 NCAADA+PalatinoLinotype TrueType WinAnsi yes yes no 126 0 NCAAEC+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 129 0 NCAACO+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 144 0 NCAADA+PalatinoLinotype TrueType WinAnsi yes yes no 147 0 NCAAEC+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 150 0 XLLNJL+VnURWPalladioL-Italic Type 1 Custom yes yes no 164 0 CKUQXN+CMSY10 Type 1 Builtin yes yes no 171 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-02-09 02:31:08 CET RepresentationInformation: 255415.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-02-08 12:27:52 CET Size: 1626872 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 374 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Methods Destination: section.2 Children: Item: Title: Study Design and Study Areas Destination: subsection.2.1 Item: Title: Study Population and Sample Destination: subsection.2.2 Item: Title: Data Collection and Questionnaire Destination: subsection.2.3 Item: Title: Variables Destination: subsection.2.4 Item: Title: Analyses Destination: subsection.2.5 Item: Title: Results Destination: section.3 Children: Item: Title: Sample Description Destination: subsection.3.1 Item: Title: Level of Use and Factors Associated with the Frequent Use of Clinical Coordination Mechanisms Destination: subsection.3.2 Item: Title: Difficulties in Use of Cross-Level Clinical Coordination Mechanisms Destination: subsection.3.3 Item: Title: Suggestions for Improvement of Cross-Level Clinical Coordination Destination: subsection.3.4 Item: Title: Discussion Destination: section.4 Children: Item: Title: Individual and Organizational Factors and Difficulties Underlying the (Low) Utilization of Coordination Mechanisms Destination: subsection.4.1 Item: Title: Three Routes Targeting Clinical Coordination: Improve Coordination Mechanisms, More Interaction between Care Levels and Institutional Support Destination: subsection.4.2 Item: Title: Limitations Destination: subsection.4.3 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.5 Info: Title: Understanding How to Improve the Use of Clinical Coordination Mechanisms between Primary and Secondary Care Doctors: Clues from Catalonia Author: Laura Esteve-Matalí, Ingrid Vargas, Franco Amigo, Pere Plaja, Francesc Cots, Erick F. Mayer, Joan-Manuel Pérez-Castejón and María-Luisa Vázquez Subject: 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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