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Table 4 Doctors’ opinion on problems in the use of available care coordination mechanisms in the studied 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 Problems in use Illustrative verbatim quotes
Shared medical record A1) Difficulties in finding the information “If you see a medical history from a hospital, normally it lists the problems point by point, and normally you’d dedicate a paragraph of, I don’t know, fifteen lines to it. And in the histories from primary sometimes it’s hard to fathom exactly what the problem is with that patient (…) And, I’m telling you, they don’t write much, and it’s not well registered what problems the patients have, you know?” (secondary care doctor, Barcelona).
Clinical case conferences between PC and SC doctors B1) May hinder access to secondary care “Sometimes they (joint conferences) also complicate access a bit for some patients that you are sure should go to the specialist and until they pass through the filter of the doctor you’re dealing with, well you can’t refer them. And that, in some cases, can take some time” (primary care doctor, Girona).
Virtual consultations between PC and SC doctors C1) Limited description of reason for referral “You need to spend more time digging around in the ECAP system (EMR in primary care) or unifying it with the IMASIS system (EMR in secondary care), and try to get an overview of the situation. And if in doubt…if we detect that there really is a problem what we ask them to do is refer the patient to us and we end up examining them ourselves properly from top to bottom, and we can clear up all our doubts” (secondary care doctor, Barcelona).
C2) Don’t check their work email “I use it sometimes (email), because when, for example, they send you patients to the outpatient department (...) And when for example I reject a..., I reject a request, then I write to the doctor by email (…) and I say “look, I saw your request…” and I explain the reasons for rejecting it, you know…The surprising thing is that no, they don’t open their work email. When I send emails I ask for that thing to confirm if they’ve read it, yeah? And the surprising thing is that they don’t open their email” (secondary care doctor, Girona).
Institutional telephone D1) Difficulties in attending to phone calls “Maybe an internist calls me. So the admin staff let me know “hey, doctor so and so from Hospital del Mar is on the line”. And I’m in the middle of an appointment and I say, oh dear, if she’s calling something must have happened. And so I have to stop my appointment to talk to her, because if they take a message, maybe when I call her back she’s not there any more, or she’s on duty or whatever. It’s really difficult, isn’t it?” (primary care doctor, Barcelona).
  1. EMR electronic medical records