ArticleHealth policy and planning2018
Understanding communication breakdown in the outpatient referral process in Latin America: a cross-sectional study on the use of clinical correspondence in public healthcare networks of six countries.
Article in Health policy and planning, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A Bibliometric Analysis and Visualization of Decision Support Systems for Healthcare Referral Strategies.International journal of environmental research and public health · 2022Pooled it
- Waiting time for scheduled outpatient specialist consultations by access pathway in public hospitals in Ecuador.PloS one · 2026Article
- [Clinical coordination and strengthening of primary care for cancer diagnosis in Latin America: a scoping reviewCoordenação clínica e fortalecimento da atenção primária no diagnóstico do câncer na América Latina: revisão de escopo].Revista panamericana de salud publica = Pan American journal of public health · 2025Article
- [What do doctors suggest to improve coordination between levels? Results in six Latin American countries].Revista de salud publica (Bogota, Colombia) · 2024Article
- Specialized outpatient care for maternal and child health in PlanificaSUS areas.Revista de saude publica · 2024Article
- Lessons learnt from the process of designing care coordination interventions through participatory action research in public healthcare networks of six Latin American countries.Health research policy and systems · 2023Article
- Implementing COVID-19 surveillance through inter-organizational coordination: a qualitative study of three cities in Colombia.Health policy and planning · 2022Article
- The role of personalised professional relations across care sectors in achieving high continuity of care.BMC family practice · 2021Observational
- Understanding How to Improve the Use of Clinical Coordination Mechanisms between Primary and Secondary Care Doctors: Clues from Catalonia.International journal of environmental research and public health · 2021Article
- Can care coordination across levels be improved through the implementation of participatory action research interventions? Outcomes and conditions for sustaining changes in five Latin American countries.BMC health services research · 2020Article
- Understanding the factors influencing the implementation of participatory interventions to improve care coordination. An analytical framework based on an evaluation in Latin America.Health policy and planning · 2020Article
- Competencies to promote collaboration between primary and secondary care doctors: an integrative review.BMC family practice · 2020Review
- Article
- Interventions to Improve Clinical Coordination between Levels: Participatory Experience in a Public Healthcare Network in Xalapa, Mexico.International journal of integrated careArticle
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
An adequate use of referral and reply letters-the main form of communication between primary care (PC) and out-patient secondary care (SC)-helps to avoid medical errors, test duplications and delays in diagnosis. However, it has been little studied to date in Latin America. The aim is to determine the level and characteristics of PC and SC doctors' use of referral and reply letters and to explore influencing factors in public healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. A cross-sectional study was conducted through a survey of PC and SC doctors working in public healthcare networks (348 doctors per country). The COORDENA questionnaire was applied to measure the frequency of use and receipt of referral and reply letters, quality of contents, timeliness and difficulties in using them. Descriptive analyses were conducted and a multivariate logistic regression model was generated to assess the relationship between frequent use and associated factors. The great majority of doctors claim that they send referral letters to the other level. However, only half of SC doctors (a higher proportion in Chile and Mexico) report that they receive referral letters and <20% of PC doctors receive a reply from specialists. Insufficient recording of data is reported in terms of medical history, tests and medication and the reason for referral. The factor associated with frequent use of the referral letter is doctors' age, while the use of reply letters is associated with identifying PC doctors as care coordinators, knowing them and trusting in their clinical skills, and receiving referral letters. Significant problems are revealed in the use of referral and reply letters which may affect quality of care. Multifaceted strategies are required that foster a direct contact between doctors and a better understanding of the PC-based model.
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