Secondary Care Doctors Research Articles

Public perceptions of the Hippocratic Oath in the U.K. 2023

This paper explores public perceptions of the Hippocratic Oath (Physician’s Oath) in the U.K. Results of a questionnaire administered online to 106 adults indicated that the majority were of the opinion that their primary and secondary health care doctors had taken the Oath (88% and 86% respectively). A majority thought that nurses, paramedics, psychotherapists and graduate scientists and researchers should also take some form of professional oath. Elements of the Oath which were deemed most important included that it is a sworn oath, that doctors should not harm patients, act in the best interests of patients, abide by the principles of autonomy and informed consent and maintain patient confidentiality. A significant proportion - about 20% - of the UK public felt that doctors had forgotten their Hippocratic Oath during COVID-19 lockdowns and associated vaccination programme, suggesting that recent history may have damaged the public faith in the medical profession.

Has cross-level clinical coordination changed in the context of the pandemic? The case of the Catalan health system

BackgroundThe COVID-19 pandemic triggered numerous changes in health services organisation, whose effects on clinical coordination are unknown. The aim is to analyse changes in the experience and perception of cross-level clinical coordination and related factors of primary (PC) and secondary care (SC) doctors in the Catalan health system between 2017 and 2022.MethodsComparison of two cross-sectional studies based on online surveys by means of the self-administration of the COORDENA-CAT (2017) and COORDENA-TICs (2022) questionnaires to PC and SC doctors. Final sample n = 3308 in 2017 and n = 2277 in 2022. Outcome variables: experience of cross-level information and clinical management coordination and perception of cross-level clinical coordination in the healthcare area and related factors. Stratification variables: level of care and year. Adjusting variables: sex, years of experience, type of specialty, type of hospital, type of management of PC/SC. Descriptive bivariate and multivariate analysis using Poisson regressions models to detect changes between years in total and by levels of care.ResultsCompared with 2017, while cross-level clinical information coordination remained relatively high, with a slight improvement, doctors of both care levels reported a worse experience of cross-level clinical management coordination, particularly of care consistency (repetition of test) and accessibility to PC and, of general perception, which was worse in SC doctors. There was also a worsening in organisational (institutional support, set objectives, time available for coordination), attitudinal (job satisfaction) and interactional factors (knowledge between doctors). The use of ICT-based coordination mechanisms such as shared electronic medical records and electronic consultations between PC and SC increased, while the participation in virtual joint clinical conferences was limited.ConclusionsResults show a slight improvement in clinical information but also less expected setbacks in some dimensions of clinical management coordination and in the perception of clinical coordination, suggesting that the increased use of some ICT-based coordination mechanisms did not counteract the effect of the worsened organisational, interactional, and attitudinal factors during the pandemic. Strategies are needed to facilitate direct communication, to improve conditions for the effective use of mechanisms and policies to protect healthcare professionals and services in order to better cope with new crises.

Impact of the Proposed Closure of the NHS Practitioner Mental Health Programme for Doctors and Managers in Secondary Care

To reduce its financial deficit, NHS England decided to cull the funding of the Practitioner Health Programme (PHP), which has been providing confidential mental health services to 110,000 NHS doctors/ senior managers since 2011. This decision was announced when NHS doctors were in a dispute over pay and conditions, AND coincided with increasing prevalence of mental illness, stress and burnout. This decision raised concerns among doctors' unions, medical royal colleges, and doctors through social media. An open letter asked the Health Secretary to reconsider this decision. Access to primary care doctors was maintained. What appears not to have been considered is that around 50,000 junior doctors, including locally employed doctors and international medical graduates who are in short-term contracts or rotational attachments, are unlikely to meet the waiting time for such ‘secondary care OH services’. In addition, the elephant in the room of a massive challenge of the professional stigma that prevents doctors from accessing mental health support early seems to have been missed. This editorial briefly explores the causes of a high prevalence of stress and work-related mental illness amongst HCPs, the consequences on their overall health, employing organisations and their patients.

Impact of coordination mechanisms based on information and communication technologies on cross-level clinical coordination: A scoping review.

Coordination mechanisms based on information and communication technologies (ICTs) are gaining attention, especially since the pandemic, due to their potential to improve communication between health professionals. However, their impact on cross-level clinical coordination remains unclear. The aim is to synthesize the evidence on the impact of ICT-based coordination mechanisms on clinical coordination between primary care and secondary care (SC) doctors and to identify knowledge gaps. A scoping review was conducted by searching for original articles in six electronic databases and a manual search, with no restrictions regarding time, area, or methodology. Titles and abstracts were screened. Full texts of the selected articles were reviewed and analysed to assess the impact of each mechanism, according to the cross-level clinical coordination conceptual framework. Of the 6555 articles identified, 30 met the inclusion criteria. All had been conducted in high-income countries, most (n = 26) evaluated the impact of a single mechanism - asynchronous electronic consultations via electronic health records (EHR) - and were limited in terms of design and types and dimensions of cross-level clinical coordination analysed. The evaluation of electronic consultations showed positive impacts on the appropriateness of referrals and accessibility to SC, yet the qualitative studies also highlighted potential risks. Studies on other mechanisms were scarce (shared EHR, email consultations) or non-existent (videoconferencing, mobile applications). Evidence of the impact of ICT-based mechanisms on clinical coordination between levels is limited. Rigorous evaluations are needed to inform policies and strategies for improving coordination between healthcare levels, thus contributing to high-quality, efficient healthcare.

Sustained benefits of a generalist training programme for UK doctors: a survey-based follow-up study

ObjectivesThe study aimed to conduct a follow-up of all broad-based training (BBT) trainees who participated in the original evaluation completed in 2017. The follow-up study explored the impact of BBT...

Priorities for data collection through a prospective cohort study on gender-affirming hormone therapy in Aotearoa New Zealand: community and clinical perspectives.

Introduction Gender affirming hormone therapy (GAHT) is an important aspect of health care for many transgender and non-binary (TNB) people, but little is known about the long-term outcomes for TNB people in Aotearoa New Zealand (NZ). Pathways to access GAHT are shifting from secondary care towards primary care, so this is an opportune time to commence local research on long-term health and wellbeing outcomes for people initiating GAHT. Aim This paper aims to report on the key findings from four meetings held to inform the design of a prospective cohort study to follow the journey of people initiating GAHT in primary and secondary care settings in NZ. Methods We worked with a community advisory group of six TNB young people and sought input from 14 health care providers involved in the care of TNB people initiating GAHT (GPs, secondary care doctors, and mental health providers). Semi-structured interview schedules were used to guide discussions. Template analysis was used to initially code data based on themes identified from the interview schedule and new themes from discussions were added. Results Participants shared ideas about recruitment and data collection priorities for baseline and follow-up surveys. These included understanding the journey to starting hormone therapy (information-seeking, decision-making), access to services for GAHT initiation, appropriateness of information provision, receipt of the first prescription, goals for and experience of GAHT, and the unique needs of non-binary people. Discussion Input from a TNB advisory group and health care professionals has informed the development of a survey that will be used to understand the experience of, and outcomes for, people starting GAHT in NZ. Findings from this planned prospective cohort study have the potential to improve access to GAHT for TNB people who wish to pursue this option.

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

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.

What are doctors’ strategies to improve care coordination? Results in six Latin-American countries

Abstract Background Given the problems generated by health care fragmentation, the coordinated provision of health care has become a priority, particularly in Latin America. This communication analyses the strategies for improving clinical coordination proposed by primary and secondary care doctors from public health service networks in six countries of the region (Argentina, Brazil, Chile, Colombia, Mexico and Uruguay), and their changes between 2015 and 2017. Methods Two cross-sectional survey-based studies (2015 and 2017) were analysed with application of the COORDENA questionnaire to a total of 4311 primary and secondary care doctors from two public health service networks in each country. A descriptive analysis was carried out, stratified by country and year, of the suggestions proposed in the open question ‘What do you propose to improve clinical coordination between primary and secondary care doctors in the network? Results In all countries, the introduction or improvement of strategies and mechanisms that facilitate interaction and mutual knowledge between professionals at different care levels were highlighted, especially joint meetings, direct communication mechanisms (such as telephone and/or e-mail) and strategies to strengthen the use of the referral and counter-referral sheet. Less frequently, other organisational strategies aimed at strengthening the primary care model, improving access to secondary care and coordinating the management level of the network, were also suggested. Conclusions The results contribute to generate recommendations for the improvement of clinical coordination in health systems, based on the suggestions of doctors, a perspective that is not usually considered in the design and implementation of interventions in health services. The need to promote strategies based on mutual feedback in the design of public health policies stands out. Key messages • The design of effective interventions aimed at improving coordination requires doctors’ participation. • Strategies based on mutual feedback and communication should be promoted by healthcare organisations to improve clinical coordination.

Knowledge and use of ICT-based coordination mechanisms in three regions of Spain

Abstract Background Although there is a consensus on the potential benefits of information and communications technology (ICT) based mechanisms to improve cross-level clinical coordination, their introduction varies greatly among regions and services. The aim is to analyse the knowledge and use of digital coordination mechanisms and the factors related to the use in the health services of three autonomous communities (ACs) of the Spanish national health system. Methods Cross-sectional study based on an on-line survey by means of self-administration of the COORDENA-TICs questionnaire to primary and secondary care doctors of the health services in Catalonia (CAT) (n = 2277), Balearic Islands (BI) (n = 441), Basque Country (BC) (n = 572). Outcome variables: Knowledge and use of digital coordination mechanisms and difficulties of use. Explanatory variables: sociodemographic, labour-related, contextual, organizational, and interactional factors. Descriptive and multivariate analysis were performed to compare the ACs. Results There were some differences between the ACs: the access to and use of ICT-based coordination mechanisms in BI was limited, with the electronic health record (EHR) being the most available but infrequently used, whereas in BC and CAT there was wide access to and use of the EHR and virtual consultations between levels. In all three ACs common difficulties in EHR use emerged such as, technical problems, disorganized and/or insufficient information. Different contextual, organizational, and interactional factors were associated to their use in all three ACs. Conclusions There were differences in the type and level of implementation of ICT-based coordination mechanisms between the ACs that can be related to organizational and contextual factors, that should be further analysed. Addressing the relevant factors in each context should contribute to design effective strategies based on ICT-based coordination mechanisms to improve cross-level clinical coordination. Key messages • Implementation and use of ICT-based coordination mechanisms differed across the three ACs and could be related to differences in contextual and organizational factors in each context. • It is necessary to explore factors and difficulties related to the use of these mechanisms to develop more effective strategies to improve their use and hence impact on clinical coordination.

Lessons learnt from the process of designing care coordination interventions through participatory action research in public healthcare networks of six Latin American countries

BackgroundThe participation of health professionals in designing interventions is considered vital to effective implementation, yet in areas such as clinical coordination is rarely promoted and evaluated. This study, part of Equity-LA II, aims to analyse the design process of interventions to improve clinical coordination, taking a participatory-action-research (PAR) approach, in healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. This participatory process was planned in four phases, led by a local steering committee (LSC): (1) dissemination of problem analysis results and creation of professionals’ platform, (2) selection of problems and intervention (3) intervention design and planning (4) adjustments after evaluation of first implementation stage.MethodsA descriptive qualitative study based on documentary analysis, using a topic guide, was conducted in each intervention network. Documents produced regarding the intervention design process were selected. Thematic content analysis was conducted, generating mixed categories taken from the topic guide and identified from data. Main categories were LSC characteristics, type of design process (phases, participants’ roles, methods) and associated difficulties, coordination problems and interventions selected.ResultsLSCs of similar composition (managers, professionals and researchers) were established, with increasing membership in Chile and high turnover in Argentina, Colombia and Mexico. Following results dissemination and selection of problems and interventions (more participatory in Chile and Colombia: 200–479 participants), the interventions were designed and planned, resulting in three different types of processes: (1) short initial design with adjustments after first implementation stage, in Colombia, Brazil and Mexico; (2) longer, more participatory process, with multiple cycles of action/reflection and pilot tests, in Chile; (3) open-ended design for ongoing adaptation, in Argentina and Uruguay. Professionals’ time and the political cycle were the main barriers to participation. The clinical coordination problem selected was limited communication between primary and secondary care doctors. To address it, through discussions guided by context and feasibility criteria, interventions based on mutual feedback were selected.ConclusionsAs expected in a flexible PAR process, its rollout differed across countries in participation and PAR cycles. Results show that PAR can help to design interventions adapted to context and offers lessons that can be applied in other contexts.

Books: Building Blocks in Paediatrics: Building Bridges Between Primary and Secondary Care Doctors.

Books: Building Blocks in Paediatrics: Building Bridges Between Primary and Secondary Care Doctors.

How to do Advice and Guidance well.

The COVID-19 pandemic has accelerated a rapid expansion of digital Advice and Guidance (A&G) across UK medical and surgical specialties. Dermatology A&G requests have increased by over 400% since the onset of the pandemic in 2020, with rapid expansion of teledermatology A&G services across England. Dermatology A&G is usually carried out asynchronously through dedicated digital platforms such as the NHS e-Referral service, with streamlined conversion to referral if clinically indicated. A&G with images is advocated as the main referral pathway to dermatology specialist services in England (excluding the two-week wait suspected skin cancer pathway). Providing dermatological care through A&G requires specific clinical skill sets to ensure rapid, safe and collaborative delivery, and optimisation of educational benefit. Little published guidance is available to signpost clinicians to what constitutes a high-quality A&G request and response. This educational article discusses good clinical practice based on extensive local and national experience from primary and secondary care doctors. We cover digital communication skills, shared decision making, clinical competency, and building collaborative links between patients, referrers and specialists. High quality A&G, with agreed turn-around times and optimisation of technology can significantly streamline patient care and strengthen links between clinicians, providing it is appropriately resourced within the wider planning of elective care and outpatient activity.

Is clinical coordination across care levels different according to the secondary care medical speciality? Results from the Catalan health system.

Despite the scarce evidence, some studies suggest that cross-level clinical coordination may vary among secondary care (SC) doctors, influenced by their speciality and organisational model, including degree of decentralisation to primary care (PC). The aim was to determine the differences in experience and perception of cross-level clinical coordination and related factors according to the SC doctor's speciality in the Catalan health system. Cross-sectional study, based on an on-line survey using the COORDENA-CAT questionnaire, to SC doctors (n=1666). Descriptive and multivariate analysis were used to compare five groups of SC specialities (decentralised, hospital-based, internists/geriatricians, gynaecologist, and paediatricians), for experience, perception and factors related to coordination. When comparing with decentralised specialities, hospital-based specialities and internal medicine/geriatrics reported lower care consistency and follow up across levels, while gynaecology and paediatrics, higher accessibility. General perception of cross-level coordination was lower in hospital-based specialities (PR:0.80, 95% CI 0.72-0.89) and higher in gynaecology (PR:1.36, 95% CI 1.18-1.56). Moreover, hospital-based specialities reported a lower use of some coordination mechanisms and lower knowledge of the primary care doctors (PR:0.42, 95% CI 0.23-0.72), while gynaecology a higher knowledge (PR:2.04, 95% CI 1.22-3.45). Results show differences in experience, perception of coordination, organisational and interactional factors across specialities. These differences may be explained by their complexity, coordination needs and organisational model. Further research is needed to clarify and understand the causes of such differences and the particular needs of coordination of each speciality to identify strategies to improve cross-level clinical coordination.

A questionnaire to measure the impact of ICT-based coordination mechanisms on clinical coordination

Abstract Background In national health systems based on primary care, cross-level clinical coordination (CC) is a priority, as it may improve quality of care. Evidence on the impact of information and communication technology (ICT)-based coordination mechanisms on CC is inconclusive. The implementation of those mechanisms increased during the pandemic. The aim is to adapt the validated COORDENA-CAT questionnaire, for measuring CC, to analyse the implementation of ICT-based coordination mechanisms and its impact on CC in three regions of Spain. Methods The COORDENA-CAT questionnaire underwent a two-stage adaptation process:1) contents revision based on literature review, expert discussions, and pretest to adapt the contents and language and produce a version for each region; and 2) piloting the adapted version by self-administration of the questionnaire to primary and secondary care doctors in the health systems of two of the participating regions. Results The adapted version (COORDENA-TICs) kept most of the original contents. Main changes were on coordination mechanisms section. Pretest showed an adequate level of comprehensiveness, comprehension, sequence of themes and questions, and length. A low non-response rate was observed, with little variability or unexpected responses. The question on any difficulties encountered in answering the questionnaire revealed no relevant difficulties. The Shared Electronic Medical Record of each region was the most frequently used ICT-based coordination mechanism. Limited access to information and technical issues related to its use were the most common difficulties encountered. Suggestions for improving its use were receiving specific training on its use. Conclusions COORDENA-TICs questionnaire is a useful tool to assess utilization of ICT-based coordination mechanisms and its impact on CC from the perspective of primary and secondary care doctors. It will allow comparisons across areas, regions and to evaluate changes over time Key messages

Relational Continuity of Chronic Patients with Primary and Secondary Care Doctors: A Study of Public Healthcare Networks of Six Latin American Countries.

Despite relational continuity (RC) with the doctor being key to care quality for chronic patients, particularly in fragmented healthcare systems, like many in Latin America (LA), little is known about RC and its attributes, particularly regarding specialists. Aim: We aim to analyse chronic patients’ perceptions of RC with primary (PC) and secondary (SC) care doctors, and record changes between 2015 and 2017 in the public healthcare networks of six LA countries. An analysis of two cross-sectional studies applying the CCAENA questionnaire to chronic patients (N = 4881) was conducted in Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay. The dependent variables of RC with PC and SC doctors were: consistency, trust, effective communication, and synthetic indexes based on RC attributes. Descriptive and multivariate analyses were performed. Although the RC index was high in 2015, especially in PC in all countries, and at both levels in Argentina and Uruguay, low perceived consistency of PC and SC doctors in Colombia and Chile and of SC doctors in Mexico revealed important areas for improvement. In 2017 the RC index of SC doctors increased in Chile and Mexico, while SC doctors’ consistency in Colombia decreased. This study reveals important gaps in achieving RC with doctors, particularly in SC, which requires further structural and organisational reforms.

Making and Validating a Promotive and Preventive Effort Model for Stages 1-5 of Chronic Kidney Disease in Primary Care Services

Background: The prevalence of Chronic Kidney Disease (CKD) is continuously increasing worldwide, including in Indonesia and has become a global public health problem. With the increased number of patients with CKD and the limited number of nephrologists, primary care physicians and specialists should play an important role in providing quality sustainable prevention and treatment by improving promotive and preventive efforts in primary care. Most patients with CKD can be managed by doctors in primary care in collaboration with specialist doctors in secondary and tertiary care. However, clinical practice guidelines for promoting and preventing CKD in primary care apparently have not been optimally implemented.Objective: This research aimed to make a promotive and preventive model for stages 1-5 of CKD in primary care.Methods: This research employed a research and development strategy with the following stages: (1) Preliminary study stage (literature review), (2) Development stage (initial draft of the model) and (3) Resources validation stage (in-depth interviews).Results: Five primary care physicians, two internists and one nephrologist participated in the validation stage for the initial draft of the model. The three stages of this research obtained the pattern of doctor's practice for CKD and the feedback related to the model to be adjusted according to the condition of primary care in Indonesia.Conclusion: There is a lack of understanding and awareness of primary care physicians about prevention and treatment of CKD, and a lack of supporting examination facilities for serum creatinine and albuminuria in primary care for screening of the risk factors of CKD. A promotional and preventative model of stages 1-5 for CKD in primary care was successfully made and validated.

Evaluating the effectiveness of care coordination interventions designed and implemented through a participatory action research process: Lessons learned from a quasi-experimental study in public healthcare networks in Latin America.

Despite increasing recommendations for health professionals to participate in intervention design and implementation to effect changes in clinical practice, little is known about this strategy's effectiveness. This study analyses the effectiveness of interventions designed and implemented through participatory action research (PAR) processes in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay to improve clinical coordination across care levels, and offers recommendations for future research. The study was quasi-experimental. Two comparable networks, one intervention (IN) and one control (CN), were selected in each country. Baseline (2015) and evaluation (2017) surveys of a sample of primary and secondary care doctors (174 doctors/network/year) were conducted using the COORDENA® questionnaire. Most of the interventions chosen were based on joint meetings, promoting cross-level clinical agreement and communication for patient follow-up. Outcome variables were: a) intermediate: interactional and organizational factors; b) distal: experience of cross-level clinical information coordination, of clinical management coordination and general perception of coordination between levels. Poisson regression models were estimated. A statistically significant increase in some of the interactional factors (intermediate outcomes) -knowing each other personally and mutual trust- was observed in Brazil and Chile INs; and in some organizational factors -institutional support- in Colombia and Mexico. Compared to CNs in 2017, INs of Brazil, Chile, Colombia and Mexico showed significant differences in some factors. In distal outcomes, care consistency items improved in Brazil, Colombia and Uruguay INs; and patient follow-up improved in Chile and Mexico. General perception of clinical coordination increased in Brazil, Colombia and Mexico INs. Compared to CNs in 2017, only Brazil showed significant differences. Although more research is needed, results show that PAR-based interventions improved some outcomes regarding clinical coordination at network level, with differences between countries. However, a PAR process is, by definition, slow and gradual, and longer implementation periods are needed to achieve greater penetration and quantifiable changes. The participatory and flexible nature of interventions developed through PAR processes poses methodological challenges (such as defining outcomes or allocating individuals to different groups in advance), and requires a comprehensive mixed-methods approach that simultaneously evaluates effectiveness and the implementation process to better understand its outcomes.

Understanding how to improve the use of clinical coordination mechanisms between levels of care

Abstract Background Clinical coordination mechanisms (CCM) can play an important role in improving clinical coordination between primary (PC) and secondary care (SC) doctors, being necessary to understand the reasons hindering their use. The aim is to analyse the level of use of CCM, and the difficulties and factors associated to it. Methods Cross-sectional study based on an online survey using the COORDENA-CAT questionnaire (October-December 2017). Sample: 3308 doctors of the Catalan national health system. Outcome variables: frequent use of six CCM and difficulties in their use. Explanatory variables: sociodemographic, labour characteristics, organizational and interactional factors. Stratification variable: level of care. Analysis: descriptive bivariate and multivariate by logistic regression. Results The level of use differed according to the CCM and level of care, being lower for the different cross-level consultations (via electronic medical record -EMR: 52.36%, email: 26.11% and phone: 21.73%). Shared EMR of the organisation (81.27%) and of the region (65.89%), and joint clinical case conferences (63.28%) were the most frequently used, especially by PC doctors, and the ones presenting more difficulties in use. While the difficulties pointed to organizational problems, mostly related to computer and schedule problems, the analysis of factors pointed also to some individual factors. Working in integrated areas or with local hospitals were factors positively associated with the use of CCM. Interactional factors, such as personally knowing the other level doctor, were associated among SC doctors. Conclusions The use of CCM differed across mechanisms and level of care, and was clearly improvable. Difficulties and factors affecting their use were mostly organizational, so managerial support is required to create the appropriate conditions for their use. It is also important to strengthen interaction between doctors of different care levels to improve the use of CCM. Key messages The level of use of CCM differed according to the mechanism and level of care, and was clearly improvable. This study identifies difficulties and factors affecting their use, mainly organizational. These results are useful for managers promoting strategies to improve clinical coordination by the effective implementation of CCM, which require managerial support and interaction between doctors.

The unique information and communication needs of men affected by prostate cancer: A qualitative study of men's experience.

The objective of this study is to explore the specific information and communication needs of men affected by prostate cancer to inform the development of educational materials for clinicians. This is a qualitative descriptive study. A purposive sampling strategy was used to identify men at different cancer stages and with experience of different treatment regimens. Semistructured interviews (25) were conducted with 19 men and six carers over the phone. Interview data were analysed using a framework approach. Four themes emerged: gaps in the information provided by secondary care doctors and nurses, communication skills needed in effective clinical information provision, a need for individualised information and alternative information sources used to meet unmet needs. Regardless of cancer stage and treatment, men with prostate cancer and their carers found information regarding common and burdensome adverse effects of prostate cancer treatment particularly lacking, and their ongoing and changing information needs often overlooked. They needed information delivered in a compassionate and individually tailored manner, considering content, timing and emotional support within the context of their unique life circumstances. Clinicians often fail to recognise the need for or deliver patient-centred conversations about treatment, managing side effects and prognosis. The findings will be used to develop clinician-facing educational materials.

¿La integración de la gestión de servicios sanitarios mejora la coordinación clínica? Experiencia en Cataluña

ObjectiveTo analyze the experience and perception of clinical coordination across care levels and doctor's organizational and interactional related factors, according to the type of management integration of the healthcare services of the area, in Catalonia. MethodCross-sectional study based on an online survey by self-administration of the questionnaire COORDENA-CAT. Data collection: October–December 2017. Study population: primary and secondary care (acute and long-term care) doctors of the public Catalan health system. Sample: 3308 doctors. Outcome variables: experience and perception of clinical coordination, knowledge and use of coordination mechanisms and organizational and interactional factors; explanatory variables: area according to type of management (integrated, semi-integrated, non-integrated), socio-demographic, employment characteristics and attitude toward work. Descriptive analysis by type of area and multivariate analysis by robust Poisson regression. ResultsBetter clinical coordination was observed in integrated areas compared to those semi-integrated, mainly in relation to information transfer, adequate follow-up and perception of coordination in the area. No differences were found between integrated and non-integrated areas in the clinical coordination experience, although there were differences in perception and some related factors. There are common problems across areas, such as accessibility to secondary care. ConclusionsFew differences were found between integrated and non-integrated areas, revealing that management integration may facilitate clinical coordination but is not enough. Differences with semi-integrated areas indicate the need to promote cooperation formulas between all the providers of the territory, with common objectives and coordination mechanisms, in order to avoid inequalities in quality of care.