Has cross-level clinical coordination changed in the Catalan health system after the pandemic?

Abstract

Abstract Background The COVID-19 pandemic triggered several changes in the organization of health services, such as the acceleration of the introduction of digital tools to improve cross-level clinical coordination and, therefore, the quality of care. The aim is to analyse changes in the experience, perception of cross-level clinical coordination and related factors of primary care (PC) and secondary care (SC) doctors in the Catalan health system between 2017 and 2022. Methods Comparison of two cross-sectional studies based on the online surveys COORDENA-CAT (2017) and COORDENA-TICs (2022) to PC and SC doctors. Sample 2017 n = 3308 (participation: 20.9%); 2022 n = 2277 (participation: 17.5%). Outcome variables: experience and perception of cross-level clinical coordination, and related factors, knowledge, and use of digital coordination mechanisms. Descriptive and multivariate analyses were performed to detect changes between years. Results Compared to 2017, there was a worse experience of clinical management coordination, particularly in cross-level care consistency and accessibility, and of the perception. Regarding related factors there was a worsening in some organizational factors (time available for coordination, institutional support), attitudinal factors (satisfaction with the job) and interactional factors (knowledge between doctors). The use of some coordination mechanisms such as electronic medical records and virtual consultations between PC and SC increased, while the use of virtual joint clinical sessions was limited. Conclusions Results show that after the pandemic there was a worsening in some items of the experience and in the perception of cross-level clinical coordination, despite the increased use of some digital coordination mechanisms. There is a need to explore in depth the factors associated with this worsening to identify and promote more effective strategies to improve cross-level clinical coordination in Catalonia. Key messages • Cross-level clinical coordination in Catalonia has worsened despite the increase in implementation and use of some digital coordination mechanisms. • It is necessary to explore in depth the factors related to this worsening to develop more effective strategies to improve cross-level clinical coordination.