What do doctors suggest to improve coordination between levels? Results in six Latin American countries: Resultados en seis países de Latinoamérica

Objective To analyze the strategies for improving clinical coordination proposed by primary care (PC) and secondary care (SC) doctors from the public healthcare networks in six Latin American countries, and the changes between 2015 and 2017. Methods Two cross-sectional studies based on surveys (2015 and 2017) were developed with the application of the COORDENA questionnaire to a total of 4 311 primary and secondary care doctors from two public healthcare networks in each country. A descriptive analysis of the proposed suggestions was carried out stratified by country and year. Results In all countries, the introduction or improvement of strategies and mechanisms that ease interaction and mutual knowledge between professionals from different care levels is noted, especially joint cross-level meetings, direct communication mechanisms and strategies to strengthen the use of the referral and back-referral form. Less frequently, other organisational strategies are suggested aimed at strengthening the primary care model, access to secondary care and the coordination of the network's management. Conclusions The results allow to generate recommendations for the improvement of clinical coordination in different health systems drawn from the suggestions made by doctors, a perspective that is seldom considered in the design and implementation of interventions in healthcare services. The need to promote strategies based on mutual adjustment in the development of public health policies is highlighted.