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Table 3 Doctors’ opinion on the contribution of coordination mechanisms to clinical coordination in the healthcare networks

From: Doctors’ opinion on the contribution of coordination mechanisms to improving clinical coordination between primary and outpatient secondary care in the Catalan national health system

Mechanism Contribution to clinical care coordination Illustrative verbatim quotes
Feedback mechanisms
Shared medical record A1) Exchange of clinical information across care levels “We all have access to the same system and you can access the medical record and look up everything on a patient. Their treatments, the pathologies they have, the last appointments they’ve had, and the medical history are there so you can see more or less what their family doctor envisaged or intended and we can more or less all tow the same line, you know? So you don’t tell them, like, exactly the opposite” (secondary care doctor, Baix Empordà)
Clinical case conferences between PC and SC doctors B1) Rapid resolution of queries “We go there and we discuss our queries, yeah? Some patients, often we don’t even have to book them in (refer them) any more, we do the things they instruct or advise us to do, and then, later we explain to them how it develops and so there’s no longer any need for an appointment” (primary care doctor, Girona)
B2) Increases the response capacity of PC doctors “You also empower the doctor with certain knowledge which gives them confidence with their patients. I think it’s a very important method, I think that purely virtual (…) is great to resolve some cases but, in some cases physically having the doctor in front of you to discuss it is an added element that brings with it all this stuff I’m saying about, let’s say, the empowerment of the doctor” (secondary care doctor, Barcelona)
Virtual consultations between PC and SC doctors C1) Rapid resolution of queries “It’s fantastic, because if I have a query about a patient, what I used to do was ask about it on the phone and then I’d ask about it by email and now I don’t have to. It’s a job that’s been recorded, the specialist has their own space and I say to them “look, I’m not sure about this patient, he doesn’t seem to be a case for referral. I just wanted you to have a quick look at this and tell me what you think and what we can do”, and this way we save a lot of money, a lot of time and trips” (primary care doctor, Baix Empordà).
C2) Speed up the diagnostic process “I’ve used them a couple of times and it went well in the sense that I like to have my patients’ cases all tied up, and when I consulted them, because they solved it for me (…) and he said to me, well, order a Holter for him and if it goes well, discharge, and if not, send him to me for the cardiologist, and he let me order the Holter, because normally they order the Holter, and so they gave me that option” (primary care doctor, Baix Empordà).
Institutional telephone D1) Speeds up access to secondary care “We answer straight away, we’re delighted to. Look, the other day a doctor who works around here called me, I think he’s one of the switched on ones, with a suspected serious illness, but he called me, eh? And I told him: “Good grief, tell them to come on Thursday”, in two days they had an appointment” (secondary care doctor, Girona).
D2) Rapid resolution of queries “They call you (primary care doctors) and say “hi, what’s up, I’ve got this problem”. Well, sometimes they ask: “what should I do? Shall I send him to you or not?” And sometimes, yes, they call you to say “look, I’ve got this patient who’s got this, this and this, and I’m sending him to you”. OK. They even ask me: “what shall I give him in the meantime?”” (Secondary care doctor, Barcelona).
Mechanisms based on programming
Rapid diagnostic pathway for cancer E1) Speeds up diagnosis and treatment “If I suspect possible colon cancer, what I do is make an urgent referral to the rapid diagnostic unit (….) And in less than a week they’ve examined that patient, eh? What I mean is yes, our rapid pathway works perfectly” (primary care doctor, Baix Empordà)
Shared protocols F1) Speed up diagnosis and treatment “(Digestive medicine) has been a service that, well, has taken a long time to get going and, now with these procedures it’s improved, the waiting lists have been managed better. And so we now have the chance to request the diagnostic test directly, if it fulfils the criteria we’ve already agreed on in this protocol” (primary care doctor, Girona)
Training sessions G1) Improve the clinical appropriateness of referrals “Sometimes in the sessions, for example, urologists have come in and they say “so, patients with prostate problems (…) request analysis, rectal exam, do this, this and that. And then if everything’s fine you don’t have to refer them and the treatment will be this”. Therefore, what they’re giving you is a series of instructions so you can treat the patient but you’re also saving the patient a lot of visits” (primary care doctor, Baix Empordà).