Can coordination between levels of care be improved with interventions designed in collaboration with practitioners?
An open access article has just been published in the scientific journal BMC Health Services Research that analyses the results on care coordination between levels of care of interventions designed and implemented in a participatory manner with professionals in public health service networks in Brazil, Chile, Colombia, Mexico and Uruguay. The article also analyses the elements and strategies necessary for the sustainability of this type of intervention and its application in other contexts. The lessons learned are relevant for implementing effective interventions in health services in the current context of COVID-19.
The scientific journal BMC Health Services Research recently published a new open access article entitled: 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. The article, which is part of the Equity-LA II project and prepared in collaboration with researchers from the participating countries, analyses the results on care coordination across levels of care of interventions implemented in a participatory manner with professionals from public health service networks in Brazil, Chile, Colombia, Mexico and Uruguay. This article is of interest to practitioners, managers and policy-makers looking for more effective ways to introduce changes in their organisations and care practice that improve coordination between levels of care. Although the study was carried out before the COVID-19 pandemic, it contains recommendations of relevance to health services in the current context. A context that generates situations of high complexity and uncertainty that require rapid responses, designed and coordinated directly by the professionals involved in the care process.
The lack of concentration between levels of care is a common problem in many health systems, which raises concerns about its negative effects on the quality of care. To address this problem, numerous and variable evidence-based interventions are proposed, which often achieve limited results because they are poorly adapted to the local context and do not take into account the needs of professionals. The article shows that joint meetings between levels of care based on reflexive methods, selected and designed in a participatory way with professionals, largely contributed to improving those elements of clinical management coordination - communication in follow-up, clinical agreement, appropriateness of referral - and administrative coordination, relevant in each context. They also contributed to improving the inter-relationship factors between professionals (personal knowledge, mutual trust), as well as strengthening PHC capacity in patient follow-up. The proper application of the participatory process of selection, design and implementation of interventions with professionals, in an adequate context - with sufficient time and institutional support - emerges as a necessary condition for sustainability and applicability of interventions in other contexts.
The article presents results of the qualitative evaluation study conducted through focus groups and individual interviews with key actors (managers and practitioners) who participated in the process of selection, design and implementation of interventions to improve care coordination in the participating health service networks in each of the countries.
Other results of this study on the key contextual and process factors for the implementation of participatory interventions, as well as a framework of analysis and recommendations of interest for the implementation of this type of intervention in other contexts (https://academic.oup.com/heapol/article/35/8/962/5879869), have already been published in a previous article.
The article is signed by: I. Vargas (CSC), P. Eguiguren (UChile), A. Mogollón-Pérez (URosario), F. Bertolotto (UDELAR), I. Samico (IMIP), J. López (UVeracruz) and ML. Vázquez (CSC).Back