Has cross-level clinical coordination changed in the context of the pandemic? The case of the Catalan health system.

Background: The COVID-19 pandemic triggered numerous changes in health services organisation, whose effects on clinical coordination are unknown. The aim is to analyse changes in the experience and perception of cross-level clinical coordination and related factors of primary (PC) and secondary care (SC) doctors in the Catalan health system between 2017 and 2022.

Methods: Comparison of two cross-sectional studies based on online surveys by means of the self-administration of the COORDENA-CAT (2017) and COORDENA-TICs (2022) questionnaires to PC and SC doctors.

Is clinical coordination across care levels different according to the secondary care medical speciality? Results from the Catalan health system.

Background: Despite the scarce evidence, some studies suggest that cross-level clinical coordination may vary among secondary care (SC) doctors, influenced by their speciality and organisational model, including degree of decentralisation to primary care (PC). The aim was to determine the differences in experience and perception of cross-level clinical coordination and related factors according to the SC doctor's speciality in the Catalan health system.

Methods: Cross-sectional study, based on an on-line survey using the COORDENA-CAT questionnaire, to SC doctors (n = 1666).

Assessing the impact of clinical coordination interventions on the continuity of care for patients with chronic conditions: participatory action research in five Latin American countries.

Although fragmentation in the provision of services is considered an obstacle to effective health care, there is scant evidence on the impact of interventions to improve care coordination between primary care and secondary care in terms of continuity of care-i.e. from the patient perspective-particularly in Latin America (LA).

Optimism and social support moderate the indirect relationship between self-efficacy and happiness through mental health in the elderly.

We examined the role of self-efficacy, social support, optimism, and mental health in the prediction of happiness in the elderly. Moderated mediation analyses confirmed a full mediation in which self-efficacy, through perceived mental health and moderated by social support, predicts happiness moderated, in turn, by optimism. When an elder is self-efficacious, his or her mental well-being seems more likely to be improved and translated into enhanced happiness when social support and optimism are moderate to high.

Psychosocial Resources for Hedonic Balance, Life Satisfaction and Happiness in the Elderly: A Path Analysis.

We explored possible paths from physical and mental health-related quality of life, self-efficacy, optimism, and social support to happiness in older adults, considering hedonic balance and life satisfaction as mediators. A total of 154 Spanish male and female (50%) older adults (65-96 years old, M = 77.44, SD = 8.

[Awareness and use of mechanism for clinical coordination between levels in two health care networks in Pernambuco State, Brasil].

This article assesses awareness and use of mechanisms for clinical coordination between service levels in two health care networks in the Pernambuco State, Brasil. It is a descriptive, cross-sectional, survey-based study. We interviewed 381 doctors from the public primary health care and specialized health care networks in the cities of Caruaru and Recife (Sanitary Districts III and VII).

Has the quality of health care for the immigrant population changed during the economic crisis in Catalonia (Spain)? Opinions of health professionals and immigrant users.

Objective: To analyse changes in health professionals' and immigrant users' perceptions of the quality of care provided to the immigrant population during the crisis.

Methods: A qualitative descriptive-interpretative and exploratory study was conducted in two areas of Catalonia. Semi-structured individual interviews were used with a theoretical sample of medical (n=24) and administrative (n=10) professionals in primary care (PC) and secondary care (SC), and immigrant users (n=20).

Patient perceptions of continuity of health care and associated factors. Cross-sectional study in municipalities of central Colombia and north-eastern Brazil.

Despite the fragmentation of healthcare provision being considered one of the main obstacles to attaining effective health care in Latin America, very little is known about patients' perceptions. This paper analyses the level of continuity of health care perceived by users and explores influencing factors in two municipalities of Colombia and Brazil, by means of a cross-sectional study based on a survey of a multistage probability sample of people who had suffered at least one health problem within the previous three months (2163 in Colombia; 2167 in Brazil). An adapted and validated version of the CCAENA© (Questionnaire of care continuity across levels of health care) was applied.

Changes in access to health care for immigrants in Catalonia during the economic crisis: Opinions of health professionals and immigrant users.

Policy measures introduced in Spain during the economic crisis included a reduction in public health expenditure and in healthcare entitlements (RDL16/2012), which affected the general population as a whole, but especially immigrants. This paper analyzes changes in immigrants' access to health care during the economic crisis from the perspective of health professionals (medical and administrative) and immigrants. A qualitative descriptive-interpretative study was conducted in Catalonia through individual interviews with a theoretical sample of health professionals (n=34) and immigrant users (n=20).

Continuity of clinical management and information across care levels: perceptions of users of different healthcare areas in the Catalan national health system.

Background: The integration of health care has become a priority in most health systems, as patients increasingly receive care from several professionals in various different settings and institutions, particularly those with chronic conditions and multi-morbidities. Continuity of care is defined as one patient experiencing care over time as connected and coherent with his or her health needs and personal circumstances. The objective is to analyse perceptions of continuity of clinical management and information across care levels and the factors influencing it, from the viewpoint of users of the Catalan national health system.

Development and testing of indicators to measure coordination of clinical information and management across levels of care.

Background: Coordination across levels of care is becoming increasingly important due to rapid advances in technology, high specialisation and changes in the organization of healthcare services; to date, however, the development of indicators to evaluate coordination has been limited. The aim of this study is to develop and test a set of indicators to comprehensively evaluate clinical coordination across levels of care.

Methods: A systematic review of literature was conducted to identify indicators of clinical coordination across levels of care.

The performance of integrated health care networks in continuity of care: a qualitative multiple case study of COPD patients.

Background: Integrated health care networks (IHN) are promoted in numerous countries as a response to fragmented care delivery by providing a coordinated continuum of services to a defined population. However, evidence on their effectiveness and outcome is scarce, particularly considering continuity across levels of care; that is the patient's experience of connected and coherent care received from professionals of the different care levels over time. The objective was to analyse the chronic obstructive pulmonary disease (COPD) patients' perceptions of continuity of clinical management and information across care levels and continuity of relation in IHN of the public health care system of Catalonia.

Do existing mechanisms contribute to improvements in care coordination across levels of care in health services networks? Opinions of the health personnel in Colombia and Brazil.

Background: The fragmentation of healthcare provision has given rise to a wide range of interventions within organizations to improve coordination across levels of care, primarily in high income countries but also in some middle and low-income countries. The aim is to analyze the use of coordination mechanisms in healthcare networks and its implications for the delivery of health care. This is studied from the perspective of health personnel in two countries with different health systems, Colombia and Brazil.

[The impact of the economic crisis on the health and healthcare of the immigrant population. SESPAS report 2014].

Despite the economic crisis, the immigrant population of Spain continues to be high, with 5.7 million persons (11.4%).

Barriers in access to healthcare in countries with different health systems. A cross-sectional study in municipalities of central Colombia and north-eastern Brazil.

There are few comprehensive studies available on barriers encountered from the initial seeking of healthcare through to the resolution of the health problem; in other words, on access in its broad domain. For Colombia and Brazil, countries with different healthcare systems but common stated principles, there have been no such analyses to date. This paper compares factors that influence access in its broad domain in two municipalities of each country, by means of a cross-sectional study based on a survey of a multistage probability sample of people who had had at least one health problem within the last three months (2163 in Colombia and 2155 in Brazil).

Inequities in access to health care in different health systems: a study in municipalities of central Colombia and north-eastern Brazil.

Introduction: Health system reforms are undertaken with the aim of improving equity of access to health care. Their impact is generally analyzed based on health care utilization, without distinguishing between levels of care. This study aims to analyze inequities in access to the continuum of care in municipalities of Brazil and Colombia.

A tool for assessing continuity of care across care levels: an extended psychometric validation of the CCAENA questionnaire.

Background: The CCAENA questionnaire was developed to assess care continuity across levels from the patients' perspective. The aim is to provide additional evidence on the psychometric properties of the scales of this questionnaire.

Methods: Cross-sectional study by means of a survey of a random sample of 1500 patients attended in primary and secondary care in three health care areas of the Catalan health care system.

Are migrants health policies aimed at improving access to quality healthcare? An analysis of Spanish policies.

Although until April 2012, all Spanish citizens regardless of their origin, residence status and work situation were entitled to health care, available evidence suggested inadequate access for immigrants. Following the Aday and Andersen model, we conducted an analysis of policy elements that affect immigrants' access to health care in Spain, based on documentary analysis of national policies and selected regional policies related to migrant health care. Selected documents were (a) laws and plans in force at the time containing migrant health policies and (b) evaluations.

Safety representatives' views on their interaction with workers in a context of unequal power relations: an exploratory qualitative study in Barcelona (Spain).

Background: The interaction between workers and safety representatives (SRs), a factor that determines SRs' effectiveness, is an unexplored issue within occupational health research.

Methods: We undertook a qualitative exploratory interpretative-descriptive study by means of semi-structured interviews with SRs from Barcelona (Spain) to analyze the SRs' perspective on the interaction with workers and its determinants

Results: SRs' interaction with workers is mainly limited to information processes and to identifying occupational hazards. Prominent factors determining this interaction are associated with the way SRs understand and carry out their role, the firm sector and size, and workers' fear of dismissal, exacerbated by changes in the labor market and the current economic crisis.

A first approach to differences in continuity of care perceived by immigrants and natives in the Catalan public healthcare system.

Objective: To compare immigrants' and natives' perceptions of relational, managerial and informational continuity of care and to explore the influence of the length of stay on immigrants' perceptions of continuity.

Methods: Cross-sectional study based on a survey of a random sample of 1,500 patients, of which 22% (331) were immigrants. The study area was made up by three healthcare areas of the Catalan healthcare system.

A comprehensive analysis of patients' perceptions of continuity of care and their associated factors.

Objective: To determine the patients' perceived degree of continuity of care between primary and secondary care and to identify contextual and individual factors that influence patients' perceptions of continuity of care.

Design: Cross-sectional study by means of a survey of patients attended to in primary and secondary care.

Setting: Three health-care areas of the Catalonian public health-care system.

Changes in awareness and utilization of social participation mechanisms of the Colombian health care system in the last 10 years.

This article seeks to analyze changes in awareness and utilization of social participation mechanisms of the Colombian health care system in the last 10 years by comparing two cross-sectional studies based on surveys among health care users in 2000 and 2010. The results show that while in 2000, the level of awareness and utilization of the mechanisms were low, in 2010 researchers identified a significant tendency toward further diminishing of awareness and utilization. In both surveys, the best-known and most-used participation mechanisms were the market mechanisms.

Effects of managed care mechanisms on access to healthcare: results from a qualitative study in Colombia.

Background: Managed competition has underpinned most health sector reforms aimed at improving access and efficiency, in Latin America and other countries. The aim of the paper is to analyse barriers to healthcare that emerge from the introduction of managed care mechanisms in Colombia.

Methods: Qualitative, exploratory, and descriptive-interpretative research was carried out on the basis of case studies of four healthcare networks, comprised of insurers and their providers.

[Integrated delivery systems and other examples of collaboration among providers. SESPAS report, 2012].

Because of the steady increase in healthcare complexity, due to high specialization and the involvement of a number of services, as well as the increase in patients with chronic diseases and pluripathology, coordination has become a high-priority need in healthcare systems. The distinct regional services that comprise the decentralized Spanish National Health System have developed a number of experiences to improve collaboration among the providers involved in the healthcare process. The present article aims to analyze the experiences with integrated healthcare providers in Catalonia and the Basque Country and the chronic diseases programs of the latter.