Can care coordination across levels be improved through the implementation of participatory action research interventions? Outcomes and conditions for sustaining changes in five Latin American countries

Ingrid Vargas; Pamela Eguiguren; Amparo Susana Mogollón-Pérez; Isabella Samico; Fernando Bertolotto; Julieta López-Vázquez; Mariá Luisa Vázquez

doi:10.1186/s12913-020-05781-7

Can care coordination across levels be improved through the implementation of participatory action research interventions? Outcomes and conditions for sustaining changes in five Latin American countries

Título traducido de la contribución: ¿Puede mejorarse la coordinación asistencial entre niveles mediante la aplicación de intervenciones de investigación-acción participativa? Resultados y condiciones para mantener los cambios en cinco países de América Latina

Ingrid Vargas, Pamela Eguiguren, Amparo Susana Mogollón-Pérez, Isabella Samico, Fernando Bertolotto, Julieta López-Vázquez, Mariá Luisa Vázquez

Producción científica: Contribución a una revista › Artículo › revisión exhaustiva

8 Citas (Scopus)

Resumen

Resumen
Encontrar nuevas estrategias para la integración de la atención se ha convertido en una prioridad política para muchos sistemas de salud fragmentados en América Latina. Aunque se considera que la implementación de intervenciones mediante un enfoque de investigación-acción participativa (IAP) es más eficaz para lograr el cambio organizativo, su aplicación es escasa.
Este estudio, que forma parte del proyecto de investigación Equty LA II, tiene como objetivo analizar el impacto de las intervenciones de IAP en la coordinación entre niveles de atención, y los aspectos clave para su sostenibilidad y transferibilidad, desde el punto de vista de los actores interesados en las redes de servicios de salud de Brasil, Chile, Colombia, México y Uruguay. Se diseñaron e implementaron diferentes intervenciones a través de un proceso de IAP para mejorar la comunicación y el acuerdo clínico entre los médicos de atención primaria y secundaria: reuniones conjuntas para discutir casos clínicos y/o formación; guías de atención compartidas; consultas virtuales; mejora en los procesos de referencia-contrarreferencia; y un programa de inducción.
Métodos
Se realizó un estudio cualitativo, descriptivo-interpretativo, en la red intervención de cada país. Se llevaron a cabo grupos focales y entrevistas individuales semiestructuradas con una muestra heterogénea de participantes: miembros del comité directivo local (29) y de la plataforma profesional (28), otros profesionales sanitarios (49) y gestores (28). Se realizó un análisis de contenido temático, segmentado por país y tipo de intervención.
Resultados
Los informantes destacaron que las reuniones conjuntas basadas en métodos reflexivos contribuyeron sustancialmente a mejorar los elementos contextuales relevantes de la coordinación de la gestión clínica -seguimiento de los pacientes, acuerdo clínico, adecuación de las derivaciones- y también la coordinación administrativa. Las reuniones, junto con el proceso IAP, ayudaron a mejorar la interacción entre los profesionales -conocimiento personal y confianza mutua-, fomentando así la disposición a colaborar. El enfoque IAP, además, sirvió para difundir los problemas de coordinación y la necesidad de intervención, fomentando un mayor compromiso e interés en participar. En el resto de las intervenciones no se identificaron contribuciones dignas de mención debido a la escasa participación. Una condición necesaria para la sostenibilidad y la replicabilidad fue que el proceso de IAP se utilizara adecuadamente en un contexto favorable.
Conclusiones
Se aportan pruebas sobre la contribución sustancial de las intervenciones a la mejora de los elementos de coordinación clínica e interacción profesional relevantes cuando se aplican mediante un adecuado proceso de IAP (en términos de tiempo, método y niveles de participación), condición necesaria para su sostenibilidad y replicabilidad.

Título traducido de la contribución	¿Puede mejorarse la coordinación asistencial entre niveles mediante la aplicación de intervenciones de investigación-acción participativa? Resultados y condiciones para mantener los cambios en cinco países de América Latina
Idioma original	Inglés estadounidense
Número de artículo	941
Publicación	BMC Health Services Research
Volumen	20
N.º	1
DOI	https://doi.org/10.1186/s12913-020-05781-7
Estado	Publicada - oct. 12 2020

Áreas temáticas de ASJC Scopus

Políticas sanitarias

ODS de las Naciones Unidas

Este resultado contribuye a los siguientes Objetivos de Desarrollo Sostenible

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Vargas, I., Eguiguren, P., Mogollón-Pérez, A. S., Samico, I., Bertolotto, F., López-Vázquez, J., & Vázquez, M. L. (2020). Can care coordination across levels be improved through the implementation of participatory action research interventions? Outcomes and conditions for sustaining changes in five Latin American countries. BMC Health Services Research, 20(1), Artículo 941. https://doi.org/10.1186/s12913-020-05781-7

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title = "Can care coordination across levels be improved through the implementation of participatory action research interventions? Outcomes and conditions for sustaining changes in five Latin American countries",

abstract = "Background: Finding new strategies for care integration has become a policy priority for many fragmented health systems in Latin America. Although the implementation of interventions through a participatory action research (PAR) approach is considered to be more effective in achieving organizational change, its application is scarce. This study, part of the research project Equity-LA II, aims to analyze the impact of PAR interventions on care coordination across levels, and key aspects for their sustainability and transferability, from the stakeholder viewpoint in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay. Different interventions were designed and implemented through a PAR process to improve communication and clinical agreement between primary care and secondary care doctors: joint meetings to discuss clinical cases and/or training; shared care guidelines; offline virtual consultations; a referral and reply letter; and an induction program. Methods: A qualitative, descriptive-interpretative study was conducted in the healthcare network of each country. Focus groups and semi-structured individual interviews were conducted with a criterion sample of participants: local steering committee (29) and professional platform members (28), other health professionals (49) and managers (28). Thematic content analysis was conducted, segmented by country and type of intervention. Results: Informants highlighted that joint meetings based on reflexive methods contributed substantially to improving contextually relevant elements of clinical management coordination - communication in patient follow-up, clinical agreement, appropriateness of referrals - and also administrative coordination. The meetings, alongside the PAR process, also helped to improve interaction between professionals - knowing each other personally and mutual trust - thus fostering willingness to collaborate. The PAR approach, moreover, served to spread awareness of the coordination problems and need for intervention, encouraging greater commitment and interest in participating. No noteworthy contributions were identified in remaining interventions due to low uptake. A necessary condition for the sustainability and replicability was that PAR process had to be used appropriately in a favourable context. Conclusions: Evidence is provided on the substantial contribution of interventions to improving locally relevant clinical coordination elements and professional interaction when implemented through an adequate PAR process (in terms of time, method and participation levels), a necessary condition for their sustainability and replicability. ",

author = "Ingrid Vargas and Pamela Eguiguren and Mogoll{\'o}n-P{\'e}rez, {Amparo Susana} and Isabella Samico and Fernando Bertolotto and Julieta L{\'o}pez-V{\'a}zquez and V{\'a}zquez, {Mari{\'a} Luisa}",

note = "Funding Information: The research leading to these results, the Equity LA II project, received funding from the European Commission Seventh Framework Programme (FP7/2007–2013) under grant agreement number 305197. Publisher Copyright: {\textcopyright} 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

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Vargas, I, Eguiguren, P, Mogollón-Pérez, AS, Samico, I, Bertolotto, F, López-Vázquez, J & Vázquez, ML 2020, 'Can care coordination across levels be improved through the implementation of participatory action research interventions? Outcomes and conditions for sustaining changes in five Latin American countries', BMC Health Services Research, vol. 20, n.º 1, 941. https://doi.org/10.1186/s12913-020-05781-7

Can care coordination across levels be improved through the implementation of participatory action research interventions? Outcomes and conditions for sustaining changes in five Latin American countries. / Vargas, Ingrid; Eguiguren, Pamela; Mogollón-Pérez, Amparo Susana et al.
En: BMC Health Services Research, Vol. 20, N.º 1, 941, 12.10.2020.

Producción científica: Contribución a una revista › Artículo › revisión exhaustiva

TY - JOUR

T1 - Can care coordination across levels be improved through the implementation of participatory action research interventions? Outcomes and conditions for sustaining changes in five Latin American countries

AU - Vargas, Ingrid

AU - Eguiguren, Pamela

AU - Mogollón-Pérez, Amparo Susana

AU - Samico, Isabella

AU - Bertolotto, Fernando

AU - López-Vázquez, Julieta

AU - Vázquez, Mariá Luisa

N1 - Funding Information: The research leading to these results, the Equity LA II project, received funding from the European Commission Seventh Framework Programme (FP7/2007–2013) under grant agreement number 305197. Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2020/10/12

Y1 - 2020/10/12

N2 - Background: Finding new strategies for care integration has become a policy priority for many fragmented health systems in Latin America. Although the implementation of interventions through a participatory action research (PAR) approach is considered to be more effective in achieving organizational change, its application is scarce. This study, part of the research project Equity-LA II, aims to analyze the impact of PAR interventions on care coordination across levels, and key aspects for their sustainability and transferability, from the stakeholder viewpoint in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay. Different interventions were designed and implemented through a PAR process to improve communication and clinical agreement between primary care and secondary care doctors: joint meetings to discuss clinical cases and/or training; shared care guidelines; offline virtual consultations; a referral and reply letter; and an induction program. Methods: A qualitative, descriptive-interpretative study was conducted in the healthcare network of each country. Focus groups and semi-structured individual interviews were conducted with a criterion sample of participants: local steering committee (29) and professional platform members (28), other health professionals (49) and managers (28). Thematic content analysis was conducted, segmented by country and type of intervention. Results: Informants highlighted that joint meetings based on reflexive methods contributed substantially to improving contextually relevant elements of clinical management coordination - communication in patient follow-up, clinical agreement, appropriateness of referrals - and also administrative coordination. The meetings, alongside the PAR process, also helped to improve interaction between professionals - knowing each other personally and mutual trust - thus fostering willingness to collaborate. The PAR approach, moreover, served to spread awareness of the coordination problems and need for intervention, encouraging greater commitment and interest in participating. No noteworthy contributions were identified in remaining interventions due to low uptake. A necessary condition for the sustainability and replicability was that PAR process had to be used appropriately in a favourable context. Conclusions: Evidence is provided on the substantial contribution of interventions to improving locally relevant clinical coordination elements and professional interaction when implemented through an adequate PAR process (in terms of time, method and participation levels), a necessary condition for their sustainability and replicability.

AB - Background: Finding new strategies for care integration has become a policy priority for many fragmented health systems in Latin America. Although the implementation of interventions through a participatory action research (PAR) approach is considered to be more effective in achieving organizational change, its application is scarce. This study, part of the research project Equity-LA II, aims to analyze the impact of PAR interventions on care coordination across levels, and key aspects for their sustainability and transferability, from the stakeholder viewpoint in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay. Different interventions were designed and implemented through a PAR process to improve communication and clinical agreement between primary care and secondary care doctors: joint meetings to discuss clinical cases and/or training; shared care guidelines; offline virtual consultations; a referral and reply letter; and an induction program. Methods: A qualitative, descriptive-interpretative study was conducted in the healthcare network of each country. Focus groups and semi-structured individual interviews were conducted with a criterion sample of participants: local steering committee (29) and professional platform members (28), other health professionals (49) and managers (28). Thematic content analysis was conducted, segmented by country and type of intervention. Results: Informants highlighted that joint meetings based on reflexive methods contributed substantially to improving contextually relevant elements of clinical management coordination - communication in patient follow-up, clinical agreement, appropriateness of referrals - and also administrative coordination. The meetings, alongside the PAR process, also helped to improve interaction between professionals - knowing each other personally and mutual trust - thus fostering willingness to collaborate. The PAR approach, moreover, served to spread awareness of the coordination problems and need for intervention, encouraging greater commitment and interest in participating. No noteworthy contributions were identified in remaining interventions due to low uptake. A necessary condition for the sustainability and replicability was that PAR process had to be used appropriately in a favourable context. Conclusions: Evidence is provided on the substantial contribution of interventions to improving locally relevant clinical coordination elements and professional interaction when implemented through an adequate PAR process (in terms of time, method and participation levels), a necessary condition for their sustainability and replicability.

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Vargas I, Eguiguren P, Mogollón-Pérez AS, Samico I, Bertolotto F, López-Vázquez J et al. Can care coordination across levels be improved through the implementation of participatory action research interventions? Outcomes and conditions for sustaining changes in five Latin American countries. BMC Health Services Research. 2020 oct. 12;20(1):941. doi: 10.1186/s12913-020-05781-7