Care coordination: an analysis based on the experiences of primary care doctors

Abstract The aim of this study was to explore the experiences of primary care doctors regarding the use of knowledge and reflection to improve care coordination. We conducted a cross-sectional study with primary care doctors in Niterói, Rio de Janeiro using the COORDENA-BR questionnaire. The doctors recognized the importance of coordination, although it did not occur, and trusted the clinical skills of specialty doctors. There was no indication that their peers in specialty care recognized and promoted the centrality of primary care. Referrals, receipt of hospital discharge summaries and use of protocols were common; counter-referrals to primary services was not common. Clinical sharing sessions were not held and primary care doctors did not consult specialists to clear up doubts. The findings reveal that the coordination of care under Brazil’s public health system by primary care services is hampered by lack of technological resources, organization, and values.

摘要 本研究旨在探讨基层医疗医生运用专业知识与临床反思优化医疗照护协调的实践体验。本研究针对里约热内卢州尼泰罗伊市的基层医疗医生，采用COORDENA-BR问卷开展横断面调研。受访医生均认可医疗协调的重要性，但实际协调工作并未有效落地，且他们对专科医生的临床诊疗能力抱有信任。未有证据表明专科医疗领域的同行能够认可并凸显基层医疗的核心地位。患者转诊、接收医院出院小结以及使用临床诊疗规程的情况较为普遍，但向基层医疗单位的反向转诊则并不常见。临床共享会议未被组织开展，基层医疗医生也未向专科医生咨询以厘清诊疗疑惑。研究结果显示，巴西公共卫生体系下基层医疗服务所承担的医疗协调工作，因技术资源匮乏、组织体系不完善以及价值理念缺位而受到阻碍。