In:
PLOS ONE, Public Library of Science (PLoS), Vol. 17, No. 1 ( 2022-1-12), p. e0261604-
Abstract:
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. Methods 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. Results 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. Conclusions 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.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0261604
DOI:
10.1371/journal.pone.0261604.g001
DOI:
10.1371/journal.pone.0261604.t001
DOI:
10.1371/journal.pone.0261604.t002
DOI:
10.1371/journal.pone.0261604.t003
DOI:
10.1371/journal.pone.0261604.t004
DOI:
10.1371/journal.pone.0261604.t005
DOI:
10.1371/journal.pone.0261604.t006
DOI:
10.1371/journal.pone.0261604.s001
DOI:
10.1371/journal.pone.0261604.s002
DOI:
10.1371/journal.pone.0261604.s003
DOI:
10.1371/journal.pone.0261604.s004
DOI:
10.1371/journal.pone.0261604.s005
DOI:
10.1371/journal.pone.0261604.s006
DOI:
10.1371/journal.pone.0261604.s007
DOI:
10.1371/journal.pone.0261604.s008
DOI:
10.1371/journal.pone.0261604.s009
DOI:
10.1371/journal.pone.0261604.s010
DOI:
10.1371/journal.pone.0261604.s011
DOI:
10.1371/journal.pone.0261604.s012
DOI:
10.1371/journal.pone.0261604.r001
DOI:
10.1371/journal.pone.0261604.r002
DOI:
10.1371/journal.pone.0261604.r003
DOI:
10.1371/journal.pone.0261604.r004
DOI:
10.1371/journal.pone.0261604.r005
DOI:
10.1371/journal.pone.0261604.r006
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2022
detail.hit.zdb_id:
2267670-3
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