Abstract
Introduction:Characteristics of primary health care and emergency services may hamper their integration and, therefore, reduce the quality of care and the effectiveness of health systems. This study aims to identify and analyse policy, structural and organizational aspects of healthcare services that may affect the integration between primary health and emergency care networks.Theory and Methods:We conducted a qualitative research study based on grounded theory that included: (1) interviews with 30 health care leaders; and (2) documental analysis of the summaries of Regional Interagency Committee meetings from two regions in the state of Sao Paulo, Brazil.Results:The integration between primary health and emergency care network is inefficient. The barriers that contributed to this situation are as follows: (1) policy: the municipal health department is responsible for providing primary health care and the regional health department provides emergency care, but there is a lack of space for the integration of services; (2) structural: distinct criteria for planning mechanisms; and (3) organizational: ineffective point of interaction between different levels of the health system.Conclusions and discussion:Our findings have implications for health management and planning in low-and middle-income countries (LMICs) with suggestions for interventions for overcoming the aforementioned barriers.
Highlights
Characteristics of primary health care and emergency services may hamper their integration and, reduce the quality of care and the effectiveness of health systems
We aimed to answer the following questions: (1) Do policy, structural and organizational aspects compromise the integration of primary health care and the emergency care network in Brazil? (2) Do the primary health and emergency care network work properly? Answering these questions and identifying characteristics of health services that affect the integration of these two levels of health care may help provide guidance for the creation of interventions which enhance the quality of care and, improve healthcare indicators, care management, user satisfaction, and the cost-effectiveness of health systems
Policy, structural and organizational aspects influenced the integration between primary health care and emergency care networks
Summary
Characteristics of primary health care and emergency services may hamper their integration and, reduce the quality of care and the effectiveness of health systems. This study aims to identify and analyse policy, structural and organizational aspects of healthcare services that may affect the integration between primary health and emergency care networks. Results: The integration between primary health and emergency care network is inefficient. The barriers that contributed to this situation are as follows: (1) policy: the municipal health department is responsible for providing primary health care and the regional health department provides emergency care, but there is a lack of space for the integration of services; (2) structural: distinct criteria for planning mechanisms; and (3) organizational: ineffective point of interaction between different levels of the health system. Conclusions and discussion: Our findings have implications for health management and planning in low-and middle-income countries (LMICs) with suggestions for interventions for overcoming the aforementioned barriers
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