Experience with coordination of care between primary care physicians and specialists and related factors
| Autor(a) principal: | |
|---|---|
| Data de Publicação: | 2021 |
| Outros Autores: | , , , , |
| Tipo de documento: | Artigo |
| Idioma: | eng por |
| Título da fonte: | Cadernos de Saúde Pública |
| Texto Completo: | https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7595 |
Resumo: | 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. There is no exchange of information on diagnosis, treatment, or tests. Physicians in PHC agree more on the treatments prescribed by the specialists than vice versa, but repetition of tests is not frequent. PHC physicians refer patients to SC when necessary. Most medical specialists do not refer patients for follow-up consultations in PHC when necessary and do not give orientation to PHC physicians, who in turn fail to resolve their doubts with SC. Both PHC and specialties report long waiting times for specialist consultations. Temporary employment contracts are more common in PHC. Consultation time was considered too short for coordination between the two. Most physicians do not plan to change jobs, despite their heavy dissatisfaction with wages and work. Physicians do not know each other personally, and specialists do not identify physicians in PHC as the coordinators of care. Policies and measures to guarantee structural conditions to improve access, working conditions, and more favorable mutual adaptation need to be implemented systemically to the set of services in the Brazilian Unified National Health System (SUS). |
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Experience with coordination of care between primary care physicians and specialists and related factorsExperiência de coordenação do cuidado entre médicos da atenção primária e especializada e fatores relacionadosHealth Care LevelsComprehensive Health CareIntegrality in HealthHealth EvaluationNíveis de Atenção à SaúdeAssistência Integral à SaúdeIntegralidade em SaúdeAvaliação em SaúdeThe 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. There is no exchange of information on diagnosis, treatment, or tests. Physicians in PHC agree more on the treatments prescribed by the specialists than vice versa, but repetition of tests is not frequent. PHC physicians refer patients to SC when necessary. Most medical specialists do not refer patients for follow-up consultations in PHC when necessary and do not give orientation to PHC physicians, who in turn fail to resolve their doubts with SC. Both PHC and specialties report long waiting times for specialist consultations. Temporary employment contracts are more common in PHC. Consultation time was considered too short for coordination between the two. Most physicians do not plan to change jobs, despite their heavy dissatisfaction with wages and work. Physicians do not know each other personally, and specialists do not identify physicians in PHC as the coordinators of care. Policies and measures to guarantee structural conditions to improve access, working conditions, and more favorable mutual adaptation need to be implemented systemically to the set of services in the Brazilian Unified National Health System (SUS).El artículo analiza la coordinación de la información y gestión clínica entre niveles asistenciales en la experiencia de médicos y explora factores laborales, organizativos, de actitud frente al trabajo y de interacción relacionados. Se trata de un estudio transversal con aplicación del cuestionario COORDENA-BR; la muestra cuenta con 64 médicos de la atención primaria en salud (APS) y 56 de la atención especializada (AE) de la red pública en municipios de tamaño medio. Los resultados muestran una limitada coordinación del cuidado en la Red de Atención en Salud (RAS), con diferencias entre APS y AE. No existe intercambio de información sobre diagnóstico, tratamiento y exámenes. Médicos de la APS están más de acuerdo con los tratamientos indicados en la AE que lo contrario, a pesar de que la repetición de exámenes no es frecuente. Médicos de la APS dirigen pacientes a la AE cuando es necesario. La mayoría de los médicos de la AE no realiza derivaciones a consultas de seguimiento, cuando es necesario, y no realiza orientaciones para la APS que, a su vez, no aclara dudas con el profesional de la AE. Ambos refieren largos tiempos de espera para una consulta especializada. Los vínculos laborales temporales son más frecuentes en la APS. El tiempo de consulta se consideró insuficiente para la coordinación. La mayoría de los médicos no pretendía cambiar de empleo, aunque sea elevada la insatisfacción con salarios y trabajo. Los médicos no se conocen personalmente y los especialistas no identifican al médico de la APS como coordinador del cuidado. Políticas y acciones para la garantía de condiciones estructurales de mejoría en el acceso, de condiciones de trabajo y de adaptación mutua más favorables necesitan ser implementadas de forma sistémica para el conjunto de los servicios del Sistema Único de Salud (SUS).O artigo analisa a coordenação da informação e da gestão clínica entre níveis assistenciais na experiência de médicos e explora fatores laborais, organizacional, de atitude frente ao trabalho e de interação relacionados. Trata-se de estudo transversal com aplicação do questionário COORDENA-BR à amostra de 64 médicos da atenção primária à saúde (APS) e 56 da atenção especializada (AE) da rede pública em um município de médio porte. Os resultados mostram limitada articulação do cuidado na Rede de Atenção à Saúde (RAS), com diferenças entre APS e AE. Não há troca de informações sobre diagnóstico, tratamento e exames. Médicos da APS concordam mais com os tratamentos indicados na AE do que o contrário, porém a repetição de exames não é frequente. Médicos da APS encaminham pacientes para AE quando necessário. A maioria dos médicos da AE não realiza encaminhamento para consulta de acompanhamento, quando necessário, e não faz orientações para a APS, que por sua vez, não esclarece dúvidas com o profissional da AE. Ambos referem longos tempos de espera para consulta especializada. Vínculos laborais temporários são mais frequentes na APS. O tempo de consulta foi considerado insuficiente para a coordenação. A maioria dos médicos não pretendia mudar de emprego, embora seja elevada a insatisfação com os salários e o trabalho. Médicos não se conhecem pessoalmente e os especialistas não identificam o médico da APS como coordenador do cuidado. Políticas e ações para a garantia de condições estruturais de melhoria do acesso, de condições de trabalho e de adaptação mútua mais favoráveis precisam ser implementadas de forma sistêmica para o conjunto dos serviços do Sistema Único de Saúde.Reports in Public HealthCadernos de Saúde Pública2021-05-17info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmltext/htmlapplication/pdfapplication/pdfhttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7595Reports in Public Health; Vol. 37 No. 5 (2021): MayCadernos de Saúde Pública; v. 37 n. 5 (2021): Maio1678-44640102-311Xreponame:Cadernos de Saúde Públicainstname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZengporhttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7595/16900https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7595/16901https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7595/16902https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7595/16903Lívia dos Santos MendesPatty Fidelis de AlmeidaAdriano Maia dos SantosIsabella Chagas SamicoJéssica Prates PortoMaría-Luisa Vázquezinfo:eu-repo/semantics/openAccess2024-03-06T15:30:02Zoai:ojs.teste-cadernos.ensp.fiocruz.br:article/7595Revistahttps://cadernos.ensp.fiocruz.br/ojs/index.php/csphttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/oaicadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br1678-44640102-311Xopendoar:2024-03-06T13:08:44.457151Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ)true |
| dc.title.none.fl_str_mv |
Experience with coordination of care between primary care physicians and specialists and related factors Experiência de coordenação do cuidado entre médicos da atenção primária e especializada e fatores relacionados |
| title |
Experience with coordination of care between primary care physicians and specialists and related factors |
| spellingShingle |
Experience with coordination of care between primary care physicians and specialists and related factors Lívia dos Santos Mendes Health Care Levels Comprehensive Health Care Integrality in Health Health Evaluation Níveis de Atenção à Saúde Assistência Integral à Saúde Integralidade em Saúde Avaliação em Saúde |
| title_short |
Experience with coordination of care between primary care physicians and specialists and related factors |
| title_full |
Experience with coordination of care between primary care physicians and specialists and related factors |
| title_fullStr |
Experience with coordination of care between primary care physicians and specialists and related factors |
| title_full_unstemmed |
Experience with coordination of care between primary care physicians and specialists and related factors |
| title_sort |
Experience with coordination of care between primary care physicians and specialists and related factors |
| author |
Lívia dos Santos Mendes |
| author_facet |
Lívia dos Santos Mendes Patty Fidelis de Almeida Adriano Maia dos Santos Isabella Chagas Samico Jéssica Prates Porto María-Luisa Vázquez |
| author_role |
author |
| author2 |
Patty Fidelis de Almeida Adriano Maia dos Santos Isabella Chagas Samico Jéssica Prates Porto María-Luisa Vázquez |
| author2_role |
author author author author author |
| dc.contributor.author.fl_str_mv |
Lívia dos Santos Mendes Patty Fidelis de Almeida Adriano Maia dos Santos Isabella Chagas Samico Jéssica Prates Porto María-Luisa Vázquez |
| dc.subject.por.fl_str_mv |
Health Care Levels Comprehensive Health Care Integrality in Health Health Evaluation Níveis de Atenção à Saúde Assistência Integral à Saúde Integralidade em Saúde Avaliação em Saúde |
| topic |
Health Care Levels Comprehensive Health Care Integrality in Health Health Evaluation Níveis de Atenção à Saúde Assistência Integral à Saúde Integralidade em Saúde Avaliação em Saúde |
| description |
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. There is no exchange of information on diagnosis, treatment, or tests. Physicians in PHC agree more on the treatments prescribed by the specialists than vice versa, but repetition of tests is not frequent. PHC physicians refer patients to SC when necessary. Most medical specialists do not refer patients for follow-up consultations in PHC when necessary and do not give orientation to PHC physicians, who in turn fail to resolve their doubts with SC. Both PHC and specialties report long waiting times for specialist consultations. Temporary employment contracts are more common in PHC. Consultation time was considered too short for coordination between the two. Most physicians do not plan to change jobs, despite their heavy dissatisfaction with wages and work. Physicians do not know each other personally, and specialists do not identify physicians in PHC as the coordinators of care. Policies and measures to guarantee structural conditions to improve access, working conditions, and more favorable mutual adaptation need to be implemented systemically to the set of services in the Brazilian Unified National Health System (SUS). |
| publishDate |
2021 |
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2021-05-17 |
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info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
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article |
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publishedVersion |
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https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7595 |
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https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7595 |
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eng por |
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eng por |
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https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7595/16900 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7595/16901 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7595/16902 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7595/16903 |
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openAccess |
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text/html text/html application/pdf application/pdf |
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Reports in Public Health Cadernos de Saúde Pública |
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Reports in Public Health Cadernos de Saúde Pública |
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Reports in Public Health; Vol. 37 No. 5 (2021): May Cadernos de Saúde Pública; v. 37 n. 5 (2021): Maio 1678-4464 0102-311X reponame:Cadernos de Saúde Pública instname:Fundação Oswaldo Cruz (FIOCRUZ) instacron:FIOCRUZ |
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