Assessing the impact of clinical coordination interventions on the continuity of care for patients with chronic conditions: participatory action research in five Latin American countries

Verónica Espinel-Flores; Ingrid Vargas; Pamela Eguiguren; Amparo Susana Mogollón-Pérez; Marina Ferreira de Medeiros Mendes; Julieta López-Vázquez; Fernando Bertolotto; María Luisa Vázquez

doi:10.1093/heapol/czab130

Assessing the impact of clinical coordination interventions on the continuity of care for patients with chronic conditions: participatory action research in five Latin American countries

Título traducido de la contribución: Evaluación del impacto de las intervenciones de coordinación clínica en la continuidad asistencial de pacientes con enfermedades crónicas

Verónica Espinel-Flores
, Ingrid Vargas
, Pamela Eguiguren
, Amparo Susana Mogollón-Pérez
, Marina Ferreira de Medeiros Mendes
, Julieta López-Vázquez
, Fernando Bertolotto
, María Luisa Vázquez

Producción científica: Contribución a revista › Artículo de Investigación › revisión exhaustiva

14 Citas (Scopus)

Resumen

Aunque la fragmentación en la prestación de servicios se considera un obstáculo para la eficacia de la atención sanitaria, hay escasa evidencia sobre el impacto de las intervenciones para mejorar la coordinación asistencial entre la atención primaria y la atención secundaria en términos de continuidad de la atención -es decir, desde la perspectiva del paciente-, especialmente en América Latina (AL). En el marco del proyecto Equity-LA II, se implementaron intervenciones para mejorar la coordinación entre los niveles de atención en cinco países latinoamericanos (Brasil, Chile, Colombia, México y Uruguay) a través de un proceso de investigación-acción participativa (IAP). Este artículo analiza el impacto de estas intervenciones de IAP en la continuidad asistencial entre niveles de los pacientes crónicos en las redes sanitarias públicas. Se realizó un estudio cuasi-experimental con mediciones basadas en dos encuestas a una muestra de pacientes con enfermedades crónicas (392 por red; 800 por país). Tanto la encuesta de referencia (2015) como la de evaluación (2017) se realizaron utilizando el cuestionario CCAENA. En cada país, se seleccionaron dos redes sanitarias públicas comparables, una de intervención y otra de control. Los resultados fueron la continuidad de la información entre niveles y la continuidad de la gestión clínica. Se realizaron análisis descriptivos y se ajustaron modelos de regresión de Poisson con varianza robusta para estimar los cambios. Con diferencias entre países, los resultados mostraron mejoras en la continuidad de la información clínica entre niveles (transferencia de información clínica) y en la continuidad de la gestión clínica (coherencia asistencial). Estos resultados son consistentes con los de estudios previos sobre la efectividad de las intervenciones implementadas en cada país para mejorar la coordinación asistencial en Brasil, Chile y Colombia. Las diferencias entre los países están probablemente relacionadas con factores contextuales particulares y eventos que ocurrieron durante el proceso de implementación. Esto apoya la noción de que se necesitan ciertos factores de contexto y de proceso para mejorar la continuidad de la atención. Los resultados aportan pruebas de que, aunque las intervenciones se diseñaron para mejorar la coordinación asistencial y estaban dirigidas a los profesionales sanitarios, los pacientes informan de mejoras en la continuidad asistencial.

Título traducido de la contribución	Evaluación del impacto de las intervenciones de coordinación clínica en la continuidad asistencial de pacientes con enfermedades crónicas
Idioma original	Inglés estadounidense
Páginas (desde-hasta)	1-11
Número de páginas	11
Publicación	Health Policy and Planning
Volumen	37
N.º	1
DOI	https://doi.org/10.1093/heapol/czab130
Estado	Publicada - ene. 1 2022

ODS de las Naciones Unidas

Este resultado contribuye a los siguientes Objetivos de Desarrollo Sostenible

ODS 3: Salud y bienestar

Áreas temáticas de ASJC Scopus

Políticas sanitarias

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Espinel-Flores, V., Vargas, I., Eguiguren, P., Mogollón-Pérez, A. S., Ferreira de Medeiros Mendes, M., López-Vázquez, J., Bertolotto, F., & Vázquez, M. L. (2022). Assessing the impact of clinical coordination interventions on the continuity of care for patients with chronic conditions: participatory action research in five Latin American countries. Health Policy and Planning, 37(1), 1-11. https://doi.org/10.1093/heapol/czab130

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title = "Assessing the impact of clinical coordination interventions on the continuity of care for patients with chronic conditions: participatory action research in five Latin American countries",

abstract = "Although fragmentation in the provision of services is considered an obstacle to effective health care, there is scant evidence on the impact of interventions to improve care coordination between primary care and secondary care in terms of continuity of care-i.e. from the patient perspective-particularly in Latin America (LA). Within the framework of the Equity-LA II project, interventions to improve coordination across care levels were implemented in five Latin American countries (Brazil, Chile, Colombia, Mexico and Uruguay) through a participatory action research (PAR) process. This paper analyses the impact of these PAR interventions on the cross-level continuity of care of chronic patients in public healthcare networks. A quasi-experimental study was performed with measurements based on two surveys of a sample of patients with chronic conditions (392 per network; 800 per country). Both the baseline (2015) and evaluation (2017) surveys were conducted using the CCAENA questionnaire. In each country, two comparable public healthcare networks were selected, one intervention and one control. Outcomes were cross-level continuity of information and clinical management continuity. Descriptive analyses were conducted, and Poisson regression models with robust variance were fitted to estimate changes. With differences between countries, the results showed improvements in cross-level continuity of clinical information (transfer of clinical information) and clinical management continuity (care coherence). These results are consistent with those of previous studies on the effectiveness of the interventions implemented in each country in improving care coordination in Brazil, Chile and Colombia. Differences between countries are probably related to particular contextual factors and events that occurred during the implementation process. This supports the notion that certain context and process factors are needed to improve continuity of care. The results provide evidence that, although the interventions were designed to enhance care coordination and aimed at health professionals, patients report improvements in continuity of care.",

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Espinel-Flores, V, Vargas, I, Eguiguren, P, Mogollón-Pérez, AS, Ferreira de Medeiros Mendes, M, López-Vázquez, J, Bertolotto, F & Vázquez, ML 2022, 'Assessing the impact of clinical coordination interventions on the continuity of care for patients with chronic conditions: participatory action research in five Latin American countries', Health Policy and Planning, vol. 37, n.º 1, pp. 1-11. https://doi.org/10.1093/heapol/czab130

Assessing the impact of clinical coordination interventions on the continuity of care for patients with chronic conditions: participatory action research in five Latin American countries. / Espinel-Flores, Verónica; Vargas, Ingrid; Eguiguren, Pamela et al.
En: Health Policy and Planning, Vol. 37, N.º 1, 01.01.2022, p. 1-11.

Producción científica: Contribución a revista › Artículo de Investigación › revisión exhaustiva

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T1 - Assessing the impact of clinical coordination interventions on the continuity of care for patients with chronic conditions

T2 - participatory action research in five Latin American countries

AU - Espinel-Flores, Verónica

AU - Vargas, Ingrid

AU - Eguiguren, Pamela

AU - Mogollón-Pérez, Amparo Susana

AU - Ferreira de Medeiros Mendes, Marina

AU - López-Vázquez, Julieta

AU - Bertolotto, Fernando

AU - Vázquez, María Luisa

PY - 2022/1/1

Y1 - 2022/1/1

N2 - Although fragmentation in the provision of services is considered an obstacle to effective health care, there is scant evidence on the impact of interventions to improve care coordination between primary care and secondary care in terms of continuity of care-i.e. from the patient perspective-particularly in Latin America (LA). Within the framework of the Equity-LA II project, interventions to improve coordination across care levels were implemented in five Latin American countries (Brazil, Chile, Colombia, Mexico and Uruguay) through a participatory action research (PAR) process. This paper analyses the impact of these PAR interventions on the cross-level continuity of care of chronic patients in public healthcare networks. A quasi-experimental study was performed with measurements based on two surveys of a sample of patients with chronic conditions (392 per network; 800 per country). Both the baseline (2015) and evaluation (2017) surveys were conducted using the CCAENA questionnaire. In each country, two comparable public healthcare networks were selected, one intervention and one control. Outcomes were cross-level continuity of information and clinical management continuity. Descriptive analyses were conducted, and Poisson regression models with robust variance were fitted to estimate changes. With differences between countries, the results showed improvements in cross-level continuity of clinical information (transfer of clinical information) and clinical management continuity (care coherence). These results are consistent with those of previous studies on the effectiveness of the interventions implemented in each country in improving care coordination in Brazil, Chile and Colombia. Differences between countries are probably related to particular contextual factors and events that occurred during the implementation process. This supports the notion that certain context and process factors are needed to improve continuity of care. The results provide evidence that, although the interventions were designed to enhance care coordination and aimed at health professionals, patients report improvements in continuity of care.

AB - Although fragmentation in the provision of services is considered an obstacle to effective health care, there is scant evidence on the impact of interventions to improve care coordination between primary care and secondary care in terms of continuity of care-i.e. from the patient perspective-particularly in Latin America (LA). Within the framework of the Equity-LA II project, interventions to improve coordination across care levels were implemented in five Latin American countries (Brazil, Chile, Colombia, Mexico and Uruguay) through a participatory action research (PAR) process. This paper analyses the impact of these PAR interventions on the cross-level continuity of care of chronic patients in public healthcare networks. A quasi-experimental study was performed with measurements based on two surveys of a sample of patients with chronic conditions (392 per network; 800 per country). Both the baseline (2015) and evaluation (2017) surveys were conducted using the CCAENA questionnaire. In each country, two comparable public healthcare networks were selected, one intervention and one control. Outcomes were cross-level continuity of information and clinical management continuity. Descriptive analyses were conducted, and Poisson regression models with robust variance were fitted to estimate changes. With differences between countries, the results showed improvements in cross-level continuity of clinical information (transfer of clinical information) and clinical management continuity (care coherence). These results are consistent with those of previous studies on the effectiveness of the interventions implemented in each country in improving care coordination in Brazil, Chile and Colombia. Differences between countries are probably related to particular contextual factors and events that occurred during the implementation process. This supports the notion that certain context and process factors are needed to improve continuity of care. The results provide evidence that, although the interventions were designed to enhance care coordination and aimed at health professionals, patients report improvements in continuity of care.

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Espinel-Flores V, Vargas I, Eguiguren P, Mogollón-Pérez AS, Ferreira de Medeiros Mendes M, López-Vázquez J et al. Assessing the impact of clinical coordination interventions on the continuity of care for patients with chronic conditions: participatory action research in five Latin American countries. Health Policy and Planning. 2022 ene. 1;37(1):1-11. doi: 10.1093/heapol/czab130