Coordination mechanisms in Rosario´s municipal health network: knowledge and use. Comparative study 2015-2017

Abstract

 INTRODUCTION: In Argentina and the rest of Latin America health care systems are fragmented; care coordination mechanisms (CCM) between levels are inputs for their improvement. The objective was to analyze, as part of the project EQUITY LA II, the knowledge and use of CCM between care levels among primary care (PC) and secondary care (SC) physicians of Rosario’s public health network, and its changes between 2015 and 2017. METHODS: A cross-sectional study was conducted, based on a survey using COORDENA Argentina questionnaire with PC and SC physicians. A total of 350 (2015) and 352 (2017) physicians were surveyed. The analyzed variables were level of knowledge, frequency, purpose and difficulties in the use of mechanisms of information coordination (MIC): referral/reply letter, discharge report, phone; and clinical management coordination mechanisms (CMCM): clinical practice guidelines and joint meetings. A comparative analysis between years and care levels was carried out. RESULTS: In 2015 the majority knew MIC, although there were different percentages of use according to care level. CMCM were less known, but highly used by those who knew them. There were significant changes in 2017: reply letter delivery and phone use decreased among PC physicians. Knowledge of joint meetings and clinical practice guidelines increased among PCs. DISCUSSION: There are differences between levels in the implementation of CCM. The adaptation to the local context is key to achieve an effective and efficient implementation.