Background
In national health systems based on primary care, cross-level clinical coordination (CC) is a priority, as it may improve quality of care. Evidence on the impact of information and ...communication technology (ICT)-based coordination mechanisms on CC is inconclusive. The implementation of those mechanisms increased during the pandemic. The aim is to adapt the validated COORDENA-CAT questionnaire, for measuring CC, to analyse the implementation of ICT-based coordination mechanisms and its impact on CC in three regions of Spain.
Methods
The COORDENA-CAT questionnaire underwent a two-stage adaptation process:1) contents revision based on literature review, expert discussions, and pretest to adapt the contents and language and produce a version for each region; and 2) piloting the adapted version by self-administration of the questionnaire to primary and secondary care doctors in the health systems of two of the participating regions.
Results
The adapted version (COORDENA-TICs) kept most of the original contents. Main changes were on coordination mechanisms section. Pretest showed an adequate level of comprehensiveness, comprehension, sequence of themes and questions, and length. A low non-response rate was observed, with little variability or unexpected responses. The question on any difficulties encountered in answering the questionnaire revealed no relevant difficulties. The Shared Electronic Medical Record of each region was the most frequently used ICT-based coordination mechanism. Limited access to information and technical issues related to its use were the most common difficulties encountered. Suggestions for improving its use were receiving specific training on its use.
Conclusions
COORDENA-TICs questionnaire is a useful tool to assess utilization of ICT-based coordination mechanisms and its impact on CC from the perspective of primary and secondary care doctors. It will allow comparisons across areas, regions and to evaluate changes over time
Key messages
Evidence on the impact of ICT-based coordination mechanisms on clinical coordination is inconclusive.
COORDENA-TICs questionnaire could be useful to measure the impact of ICT-based coordination mechanisms on clinical coordination.
Background
Negative effects of the Covid-19 pandemic on access to care for other diseases are currently at debate.
Aim
To review existing literature on care access for non-Covid-19 conditions since ...the pandemic onset.
Methods
Scoping review using various databases (Medline, VHL, Web of Science, 2020/21). Terms used: ‘access', ‘health services', ‘Covid-19'. Out of 4,060 identified articles, 37 were selected after reviewing and assessing titles, abstracts and full text. Aday and Andersen's framework guided the analysis.
Results
Of selected articles, 21 analyse impact on health services use; 8 on performance; 8 on access barriers. Most analyse specific services during early pandemic stages through register review, showing an initial decline in use with inconsistent results on recovery. Some indicate increased complexity of treated patients and treatment delays. Studies surveying professionals analyse the impact on services performance or clinical practice, reporting a decrease in consultations/interventions for diverse pathologies and response implementation (e.g. telemedicine), but not how they affected access. Few studies focus on social inequalities in use, showing a greater reduction in low-income or ethnic minority users. Studies on unmet needs, access or barriers based on user surveys or qualitative methods are scarce, focused on a pathology or clinical area. Particularly in Spain, studies analyse impact on use of emergency, primary care and cancer diagnosis, and on emergency and cardiology services functioning. Studies based on user surveys are lacking: only a qualitative study analysed access difficulties for chronic patients in confinement. Methodological weaknesses are identified.
Conclusions
Although currently emerging, studies analysing the pandemic impact on equal access to care for non-Covid-19 conditions are scarce, limited in focus and methodology, especially in Spain. Comprehensive medium/long-term impact assessments, including analysis of causes, are needed.
Key messages
Research is lacking on the impact of the COVID-19 pandemic on healthcare access, particularly for vulnerable groups.
Further evidence is needed to improve health systems resilience in the future.
Background
Clinical coordination mechanisms (CCM) can play an important role in improving clinical coordination between primary (PC) and secondary care (SC) doctors, being necessary to understand the ...reasons hindering their use. The aim is to analyse the level of use of CCM, and the difficulties and factors associated to it.
Methods
Cross-sectional study based on an online survey using the COORDENA-CAT questionnaire (October-December 2017). Sample: 3308 doctors of the Catalan national health system. Outcome variables: frequent use of six CCM and difficulties in their use. Explanatory variables: sociodemographic, labour characteristics, organizational and interactional factors. Stratification variable: level of care. Analysis: descriptive bivariate and multivariate by logistic regression.
Results
The level of use differed according to the CCM and level of care, being lower for the different cross-level consultations (via electronic medical record -EMR: 52.36%, email: 26.11% and phone: 21.73%). Shared EMR of the organisation (81.27%) and of the region (65.89%), and joint clinical case conferences (63.28%) were the most frequently used, especially by PC doctors, and the ones presenting more difficulties in use. While the difficulties pointed to organizational problems, mostly related to computer and schedule problems, the analysis of factors pointed also to some individual factors. Working in integrated areas or with local hospitals were factors positively associated with the use of CCM. Interactional factors, such as personally knowing the other level doctor, were associated among SC doctors.
Conclusions
The use of CCM differed across mechanisms and level of care, and was clearly improvable. Difficulties and factors affecting their use were mostly organizational, so managerial support is required to create the appropriate conditions for their use. It is also important to strengthen interaction between doctors of different care levels to improve the use of CCM.
Key messages
The level of use of CCM differed according to the mechanism and level of care, and was clearly improvable. This study identifies difficulties and factors affecting their use, mainly organizational.
These results are useful for managers promoting strategies to improve clinical coordination by the effective implementation of CCM, which require managerial support and interaction between doctors.
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