Factors influencing participatory intervention implementation to improve care coordination

Abstract

Abstract Background Problems related to care coordination are identified as challenges to the organization of health systems. In order to improve coordination, it is necessary to invest in interventions that promote collaboration between levels of care. The study analyzes factors influencing the implementation of the intervention joint meetings between levels of care, guided by participatory action research to improve clinical coordination from the perspective of actors involved in a public health care network in Brazil. Methods Qualitative descriptive-interpretative study carried out in the health network of a municipality in the northeast of Brazil. Ten interviews were conducted to managers and health professionals, members of local steering committee and focus group with primary care physicians and specialists participating in the intervention. Thematic content analysis was used; it generated categories from theoretical and emerging frameworks. Results The willingness of professionals and management support to participate of the intervention process emerge as fundamental factors. However, they are influenced by factors of the system, such as electoral period and management change and these reflected on the slowdown and instability in implementation process. In the health network, turnover of professionals and low trust between primary and specialized care were evidenced as challenges. However, the proactive role of local steering committee, driven by participatory strategy for development of the intervention, promoted reflections and decisions agreed between professionals and managers. This rebounded on adjustments to strengthen the intervention and improvements on knowledge and collaboration between levels. Conclusions analysis of factors contributes to reflection on changes in the context, adaptation of intervention over time and importance of the role of professionals. Such understanding becomes essential for sustainability and improvement of care coordination. Key messages Knowledge about factors that influence implementation of an intervention guided by participatory action research contributes to the development of strategies aimed at its sustainability. Contextual factors that hamper improvements implementation to coordination of care can be overcome through participatory strategies mobilizing health professionals and managers.