Knowledge |
“[...] to facilitate… the district sometimes makes meetings to discuss […] to where are made the referrals, in the sense of trying to improve. […] here in the network we have the matrix [support], but then it comes working more to the psychological area, […] because of the NASF team” (P2-PH).
“Unless we have a hospital stay, then sometimes we have the hospital discharge summary, but it’s not always.” (N2-PH).
“They [PH professionals] send, […] in the referral summary, but […] sometimes without anything written, almost nothing, […] in my practice I don’t find anything, only paper” (P7-SC).
“Now they are sending a, a form, only for regulation [regulation form] […] there is no more [case discussion], between levels, at least not here.” (P8-SC).
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Utility |
“[...] I think it would improve a lot, since we, we have the attention when writing the referral, […] with conscience and well written and if the colleague also had the kindness of reading the referral, […] make his/her reference in the same way […] it would be a great benefit for the patient” (P2-PH).
“[…] in my opinion, it’s better when it’s printed because I reply. Then for those who receive and also for some who sent me, the sent with details, the cases. So I think it facilitates and also communication by phone.” (P4-SC).
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Utilization |
“Then he [patient] tells me that the cardiologist has done that, the endocrinologist has done that, but not because the endocrinologist sent me a counter-reference. So we never receive, never, never, really.” (P3-PH).
“If physicians [from SC] read the referral, for example, they would have an idea of what that patient really has, didn’t have to ask […] So […] it would really help and avoid loss of their time […] it would be good and I think it would help the patient as well” (P3 PH).
“[…] called [management] this way, in this case, physicians and nurses, to bring cases to be discussed there in a meeting [matrix team] and this meeting was being monthly and was very good because in this way, we brought complicate cases which we couldn’t get the demand and in time we discussed and things worked a little, they even manage to get exams, appointments and we could resolve it in some cases.” (P1-PH).
“[…] because you come and there is a lot of patient for you to look upon […] there is no way for you to stop and talk with someone, send a message and stuff like that. Because you won’t have when you receive this reply back.” (P6-SC).
“To tell the truth I don’t have much contact [with professionals from primary care], because the amount of patients here is huge and we keep dealing with the demand. I don’t really fell that this feedback... exists” (P7-SC).
“[…] counter-reference doesn’t exist. [...] we only have the prescription made by him, when the patient manages to go there.” (N1-PH).
“Matrix support in the network I don’t really think that it exists, they can even claim that it does […]. I never saw a meeting.” (P8-SC).
“So we see that, not always, the information from the patient is trustworthy, so if we really have it written, it will be easier. It can really generate this issue of double treatment.” (P4-SC).
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Informal Mechanisms |
“[...] when it is necessary, I use exactly the best reference and counter-reference which is the cell phone, I call the colleague directly […] it works a lot better than sometimes the paper does, because sometimes the colleague doesn’t read the paper, right? And when we call and identify ourselves, he sometimes remembers who is that patient and we talk about he/her […]” (P2-PH).
“[…] counter-reference doesn’t exist. [...] we only have the prescription made by him, when the patient manages to go there.” (N1-PH).
“[…] the channel of care is the whatsapp, [...] while is not being demanded, is my method of communication.” (N3-SC).
“[…] they [PH physicians] ask to come, I think it is a more informal way, […] then they come, like, two, three, ambulatories or more. Then we know each other, as well, and start asking questions.” (P4-SC).
“I can do it because of friendship in (reference unit) with my cardiologist friends, then I can do it, but it is very difficult through network” (P8-SC).
“Then we always ask him (patient) to show the prescription to the other physician [PH] […] check out the changes the specialist did. Which they usually accept because it’s usually the specialist who is sending” (P5- SC).
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