[Factors influencing coordination among healthcare levels according to the opinion of healthcare managers and health professionals]

Abstract

Objective: To analyze coordination among healthcare levels from the viewpoint of healthcare managers and health professionals in integrated healthcare systems (IHS).

Methods: A qualitative, exploratory and descriptive study was conducted by means of individual semi-structured interviews to a criterion sample. We performed two-stage sampling: in the first stage, IHS were selected and in the second, managers (n=18) and professionals (n=23). A content analysis was carried out with mixed generation of categories, segmented by themes and informants.

Results: Coordination among healthcare levels was defined differently by the two groups of informants. However, the informants agreed that coordination was complicated but necessary to improve access to and the efficiency of the system. Factors central to achieving coordination were communication, knowledge and good relationships among professionals. These factors were influenced by professionals' values and the existence of appropriate institutional coordination mechanisms. In turn, these elements depended mainly on internal but also external structural and organizational conditions, which determined the development of coordination. Improvement strategies were directly related to the factors identified.

Conclusions: Opinions on healthcare coordination reflect not only the complexity of the concept, but also the traditional separation of healthcare levels. Improving coordination requires specific organizational interventions to address its determinants, not only within but also among all healthcare providers in an area.