Understanding the health system drivers of delayed cancer diagnosis in public healthcare networks of Chile, Colombia and Ecuador: A qualitative study with health professionals, managers and policymakers.

Although the greatest delays in cancer diagnosis in Latin America occur in the provider interval little is known about the related factors. This study aims to analyze factors influencing access to cancer diagnosis -from initial contact with health services to confirmation- from institutional stakeholders' perspective in public healthcare networks of Chile, Colombia, and Ecuador. A qualitative, descriptive-interpretative study was conducted in two networks per country, using semi-structured individual interviews (n = 118; 23 to 58, per country) with a criterion sample of health professionals and administrative personnel from primary care (PC) (n = 41) and secondary/tertiary care hospitals (n = 47), network managers and policymakers (n = 30).

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.

Impact of coordination mechanisms based on information and communication technologies on cross-level clinical coordination: A scoping review.

Background: Coordination mechanisms based on information and communication technologies (ICTs) are gaining attention, especially since the pandemic, due to their potential to improve communication between health professionals. However, their impact on cross-level clinical coordination remains unclear. The aim is to synthesize the evidence on the impact of ICT-based coordination mechanisms on clinical coordination between primary care and secondary care (SC) doctors and to identify knowledge gaps.

Lessons learnt from the process of designing care coordination interventions through participatory action research in public healthcare networks of six Latin American countries.

Background: The participation of health professionals in designing interventions is considered vital to effective implementation, yet in areas such as clinical coordination is rarely promoted and evaluated. This study, part of Equity-LA II, aims to analyse the design process of interventions to improve clinical coordination, taking a participatory-action-research (PAR) approach, in healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. This participatory process was planned in four phases, led by a local steering committee (LSC): (1) dissemination of problem analysis results and creation of professionals' platform, (2) selection of problems and intervention (3) intervention design and planning (4) adjustments after evaluation of first implementation stage.

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).

Improving equity in access to early diagnosis of cancer in different healthcare systems of Latin America: protocol for the EquityCancer-LA implementation-effectiveness hybrid study.

Introduction: Healthcare fragmentation, a main cause for delay in cancer diagnosis and treatment, contributes to high mortality in Latin America (LA), particularly among disadvantaged populations. This research focuses on integrated care interventions, which have been limitedly implemented in the region. The objective is to evaluate the contextual effectiveness of scaling-up an integrated care intervention to improve early diagnosis of frequent cancers in healthcare networks of Chile, Colombia and Ecuador.

Relational Continuity of Chronic Patients with Primary and Secondary Care Doctors: A Study of Public Healthcare Networks of Six Latin American Countries.

Despite relational continuity (RC) with the doctor being key to care quality for chronic patients, particularly in fragmented healthcare systems, like many in Latin America (LA), little is known about RC and its attributes, particularly regarding specialists. Aim: We aim to analyse chronic patients' perceptions of RC with primary (PC) and secondary (SC) care doctors, and record changes between 2015 and 2017 in the public healthcare networks of six LA countries. An analysis of two cross-sectional studies applying the CCAENA questionnaire to chronic patients (N = 4881) was conducted in Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay.

Implementing joint training sessions of general practitioners and specialists aimed at improving clinical coordination in Colombia: Contributions from participatory action research.

Objective: To analyse the contribution of participatory action research (PAR) in designing and implementing joint training sessions as a means to improve clinical coordination in a public health care network in Bogotá, Colombia.

Methods: A qualitative, descriptive-interpretative study using semi-structured individual interviews and focus groups with 40 professionals (GPs, specialists, members of the local steering committee (LSC) and network middle managers) involved in designing and implementing joint training sessions to improve cross-level clinical coordination. The intervention consisted of two forms of joint training sessions for GPs and specialists, implemented through two PAR cycles.

Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review.

The COVID-19 pandemic and the measures adopted are having a profound impact on a major goal of public healthcare systems: universal access to health services. The objective is to synthesize the available knowledge on access to health care for non-COVID-19 conditions and to identify knowledge gaps. A scoping review was conducted searching different databases (Medline, Google Scholar, etc.

Evaluating the effectiveness of care coordination interventions designed and implemented through a participatory action research process: Lessons learned from a quasi-experimental study in public healthcare networks in Latin America.

Background: Despite increasing recommendations for health professionals to participate in intervention design and implementation to effect changes in clinical practice, little is known about this strategy's effectiveness. This study analyses the effectiveness of interventions designed and implemented through participatory action research (PAR) processes in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay to improve clinical coordination across care levels, and offers recommendations for future research.

Methods: The study was quasi-experimental.

Interventions to Improve Clinical Coordination between Levels: Participatory Experience in a Public Healthcare Network in Xalapa, Mexico.

Introduction: Coordination of care can be improved through an intervention or a combination of several ones. In addition, it is recommended to encourage the active involvement of professionals in the design, implementation and assessment of coordination mechanisms.

Objective: To analyse the factors that influence the implementation of participatively designed interventions and their effects on clinical coordination between levels of care in a public healthcare network of health services in Xalapa, Veracruz, Mexico.

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).

[Does the integration of health services management improve clinical coordination? Experience in Catalonia].

Objective: To analyze the experience and perception of clinical coordination across care levels and doctor's organizational and interactional related factors, according to the type of management integration of the healthcare services of the area, in Catalonia.

Method: Cross-sectional study based on an online survey by self-administration of the questionnaire COORDENA-CAT.

Data Collection: October-December 2017.

Experience with coordination of care between primary care physicians and specialists and related factors.

The article analyzes the coordination of information and clinical management between levels of care in physicians' experience and explores related labor and organizational factors and attitudes towards the work and interaction. This is a cross-sectional study with application of the COORDENA-BR questionnaire to a sample of 64 primary health care (PHC) physicians and 56 specialized care (SC) from the public system in a medium-sized Brazilian city. The results show limited linkage of care in the Healthcare Network (RAS), with differences between PHC and SC.

[Barriers and factors associated with the use of coordination mechanisms between levels of care in Mexico].

The aim was to analyze the level and characterize the use of clinical coordination mechanisms between levels of care, and their associated factors, in two public networks of health services in Mexico. A cross-sectional study was carried out using the COORDENA questionnaire to primary and specialized care physicians in the state of Veracruz. Differences were found between networks and levels of care, according to the mechanism.

Understanding How to Improve the Use of Clinical Coordination Mechanisms between Primary and Secondary Care Doctors: Clues from Catalonia.

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.

Can care coordination across levels be improved through the implementation of participatory action research interventions? Outcomes and conditions for sustaining changes in five Latin American countries.

Background: Finding new strategies for care integration has become a policy priority for many fragmented health systems in Latin America. Although the implementation of interventions through a participatory action research (PAR) approach is considered to be more effective in achieving organizational change, its application is scarce. This study, part of the research project Equity-LA II, aims to analyze the impact of PAR interventions on care coordination across levels, and key aspects for their sustainability and transferability, from the stakeholder viewpoint in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay.

Changes in knowledge and use of clinical coordination mechanisms between care levels in healthcare networks of Colombia.

Clinical coordination mechanisms (CCMs) have become key tools in healthcare networks for improving coordination between primary care (PC) and secondary care (SC) and are particularly relevant in health systems with highly fragmented healthcare provision. However, their implementation has been little studied to date in Latin America and particularly in Colombia. This study analyses the level of knowledge and use of CCMs between care levels and their changes between 2015 and 2017 in two public healthcare networks in Bogotá, Colombia.

Care continuity across levels of care perceived by patients with chronic conditions in six Latin-American countries.

Objective: To analyse the care continuity across levels of care perceived by patients with chronic conditions in public healthcare networks in six Latin American countries (Argentina, Brazil, Chile, Colombia, Mexico and Uruguay), and to explore associated factors.

Method: Cross-sectional study by means of a survey conducted to a random sample of chronic patients in primary care centres of the study networks (784 per country) using the questionnaire Cuestionario de Continuidad Asistencial Entre Niveles de Atención (CCAENA)©. Patients had at least one chronic condition and had used two levels of care in the 6 months prior to the survey for the same medical condition.

Do primary and secondary care doctors have a different experience and perception of cross-level clinical coordination? Results of a cross-sectional study in the Catalan National Health System (Spain).

Background: Clinical coordination across care levels is a priority for health systems around the world, especially for those based on primary health care. The aim of this study is to analyse the degree of clinical information and clinical management coordination across healthcare levels in the Catalan national health system experienced by primary (PC) and secondary care (SC) doctors and explore the associated factors.

Methods: Cross-sectional study based on an online survey using the self-administered questionnaire COORDENA-CAT.

[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).

Correction to: Relational continuity with primary and secondary care doctors: a qualitative study of perceptions of users of the Catalan national health system.

Following publication of the original article [1], the authors reported a correction in affiliation of Maria Luisa Vázquez, who is affiliated with Health Policy and Health Services Research Group, which is number 1 instead of being affiliated with Grup de Recerca en Serveis Sanitaris i Resultats en Salut, Serveis de Salut Integrats Baix Empordà, Carrer Hospital 17-19 Edifici Fleming, 17,230 Palamós, Spain.

Relational continuity with primary and secondary care doctors: a qualitative study of perceptions of users of the Catalan national health system.

Background: In the current context of increasingly fragmented healthcare systems where patients are seen by multiple doctors in different settings, patients' relational continuity with one doctor is regaining relevance; however little is known about relational continuity with specialists. The aim of this study is to explore perceptions of relational continuity with primary care and secondary care doctors, its influencing factors and consequences from the viewpoint of users of the Catalan national health system (Spain).

Methods: We conducted a descriptive-interpretative qualitative study using a two-stage theoretical sample; (i) contexts: three healthcare areas in the Catalan national health system with differing characteristics; (ii) informants: users 18 years or older attended to at both care levels.

Understanding communication breakdown in the outpatient referral process in Latin America: a cross-sectional study on the use of clinical correspondence in public healthcare networks of six countries.

An adequate use of referral and reply letters-the main form of communication between primary care (PC) and out-patient secondary care (SC)-helps to avoid medical errors, test duplications and delays in diagnosis. However, it has been little studied to date in Latin America. The aim is to determine the level and characteristics of PC and SC doctors' use of referral and reply letters and to explore influencing factors in public healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay.